| NPI | 1740929462 |
|---|---|
| Former Name | SHANNON ELIZABETH MCCAUL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2022032019) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61871) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-10-29 |