Provider Demographics
NPI:1295841757
Name:SHANNON & HUNTER PC
Entity type:Organization
Organization Name:SHANNON & HUNTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON PRESID
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-682-5255
Mailing Address - Street 1:203 TURNPIKE STREET
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:NORTH ANDOVOR
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-682-5255
Mailing Address - Fax:978-682-0656
Practice Address - Street 1:203 TURNPIKE ST
Practice Address - Street 2:STE G-2
Practice Address - City:NORTH ANDOVOR
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-682-5255
Practice Address - Fax:978-682-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty