Provider Demographics
NPI:1063897528
Name:HOLCOMB, SHANNON E (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:E
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3107
Mailing Address - Country:US
Mailing Address - Phone:252-247-2169
Mailing Address - Fax:252-247-9563
Practice Address - Street 1:405 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3107
Practice Address - Country:US
Practice Address - Phone:252-247-2169
Practice Address - Fax:252-247-9563
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice