Active NPI
Shannon Lorraine Rea, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Ottumwa, IA
National Provider Identifier
1154766202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 08954
- Practice address
- 727 Pennsylvania Ave
Ottumwa, IA 52501-2153 - Phone
- (641) 682-8143
- NPI assigned
- May 2, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 08954 | IA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 08954 | IA | Primary |
Addresses
Primary practice location
727 Pennsylvania Ave
Ottumwa, IA 52501-2153
Mailing address
727 Pennsylvania Ave
Ottumwa, IA 52501-2153
Phone (641) 682-8143
Other practice location 1
110 N E St
Oskaloosa, IA 52577-2041
Phone (641) 673-4120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08954 | IA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708473600000",
"number": "1154766202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 PENNSYLVANIA AVE",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525012153",
"telephone_number": "641-682-8143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "727 PENNSYLVANIA AVE",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525012153",
"telephone_number": "641-682-8143"
}
],
"practiceLocations": [
{
"address_1": "110 N E St",
"address_purpose": "LOCATION",
"city": "Oskaloosa",
"state": "IA",
"postal_code": "525772041",
"country_code": "US",
"telephone_number": "641-673-4120",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REA",
"first_name": "SHANNON",
"middle_name": "LORRAINE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-02",
"last_updated": "2024-02-21",
"certification_date": "2024-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "08954",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IA",
"license": "08954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.