Active NPI
Shannon Dudley Vann, DDS
- General Practice Dentistry
- Rural Hall, NC
National Provider Identifier
1467560185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7974
- Practice address
- 110 E Wall St
Rural Hall, NC 27045-9312 - Phone
- (336) 969-6888
- Fax
- (336) 969-5101
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7974 | NC | Primary |
Addresses
Primary practice location
110 E Wall St
Rural Hall, NC 27045-9312
Mailing address
PO Box 39
110 E Wall Street
Rural Hall, NC 27045-0039
Phone (336) 969-6888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5901049 | Medicaid | NC | |
| 9021N | Other | BLUE CROSS BLUE SHIELD NC |
Other names 1
- Shannon Rebecca Dudley
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 |
|---|---|---|---|
| 7974 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201305600000",
"number": "1467560185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 39",
"address_2": "110 E WALL STREET",
"city": "RURAL HALL",
"state": "NC",
"postal_code": "270450039",
"telephone_number": "336-969-6888",
"fax_number": "336-969-5101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E WALL ST",
"city": "RURAL HALL",
"state": "NC",
"postal_code": "270459312",
"telephone_number": "336-969-6888",
"fax_number": "336-969-5101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANN",
"first_name": "SHANNON",
"middle_name": "DUDLEY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2008-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "7974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5901049",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "9021N",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "DUDLEY",
"middle_name": "REBECCA",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Rural Hall, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.