Provider Demographics
NPI:1063876316
Name:WOODROW, SHANNON LYNAE (RDH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNAE
Last Name:WOODROW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 WYOMING BLVD NE STE A4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6941
Mailing Address - Country:US
Mailing Address - Phone:505-821-1433
Mailing Address - Fax:
Practice Address - Street 1:7007 WYOMING BLVD NE STE A4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6941
Practice Address - Country:US
Practice Address - Phone:505-821-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist