Provider Demographics
NPI:1124297635
Name:CHIRCO, SHANNA (DDS)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:CHIRCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 HOWARD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3699
Mailing Address - Country:US
Mailing Address - Phone:562-430-7310
Mailing Address - Fax:
Practice Address - Street 1:3532 HOWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3699
Practice Address - Country:US
Practice Address - Phone:562-430-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist