Jack A Shannon, DDS Valid NPI
Individual provider · Dentist · Taft, OK
- NPI
- 1366746117
- Type
- Individual (Type 1)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- 5531 (OK)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2011-01-07
- Last updated
- 2011-01-07
Practice location
601 S 124th St. West
Taft, OK 74463
(918) 682-7841