Bryan J Shanahan, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4241 Issued in AZ

Practice address

750 N Kendrick St Ste 100
Flagstaff, AZ 86001-3067

Phone

(928) 774-2500

NPI assigned

Nov 16, 2006

Last updated

Mar 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bryan J Shanahan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1265505226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N KENDRICK ST STE 100",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013067",
            "telephone_number": "928-774-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N KENDRICK ST STE 100",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013067",
            "telephone_number": "928-774-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANAHAN",
        "first_name": "BRYAN",
        "middle_name": "J",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "4241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "860783790",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRYAN",
            "last_name": "SHANAHAN",
            "middle_name": "J",
            "credential": "D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sequelcare of Arizona, LLC
• Colleen Seung, MS, RDN
• Kathryn Shadek
• Muhammad Waseem Shahid, MD
• Muhammad Aquil Shaikh, M.D.
• Taylor Kathryn Shannon, CRNA
• Emily Somer Shapland, DPT
• Allison Sharp, PHARMD
• Aaron Brett Shaw
• Daniel Leonard Shaw, M.D.

• General Practice Dentistry in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.