Provider Demographics
NPI:1962728733
Name:DOYLE, SHANNON O (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:O
Last Name:DOYLE
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 1:4500 SENAC DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2704
Mailing Address - Country:US
Mailing Address - Phone:504-666-4220
Mailing Address - Fax:
Practice Address - Street 1:2727 HOUMA BLVD
Practice Address - Street 2:STE. A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6603
Practice Address - Country:US
Practice Address - Phone:504-454-5880
Practice Address - Fax:504-454-8332
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice