Provider Demographics
NPI:1871781922
Name:SHANNON, DAVID HARVEY (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HARVEY
Last Name:SHANNON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1672
Mailing Address - Country:US
Mailing Address - Phone:818-706-8783
Mailing Address - Fax:818-889-8511
Practice Address - Street 1:5920 GREENBRIAR CT
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1672
Practice Address - Country:US
Practice Address - Phone:818-706-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25030122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist