Robert Edward Shannon Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

1505 Issued in SC

Practice address

754 Wilson Street Extension
Chester, SC 29706-0840

Phone

(803) 377-1997

Fax

(803) 581-7332

NPI assigned

Feb 7, 2007

Last updated

Jul 8, 2007By 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

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Reid Dentistry LLC

  • Dental Clinic/Center
  • Chester, SC
  • NPI 1629883400
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497895916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840",
            "city": "CHESTER",
            "state": "SC",
            "postal_code": "297060840",
            "telephone_number": "803-377-1997",
            "fax_number": "803-581-7332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 WILSON STREET EXTENSION",
            "city": "CHESTER",
            "state": "SC",
            "postal_code": "297060840",
            "telephone_number": "803-377-1997",
            "fax_number": "803-581-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ROBERT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "1505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tierra Mochellrie Scott
• Senior Services, Inc. of Chester County
• Senior Services, Inc. of Chester County
• Bonnie Lou Shannon, LPC
• Janice Shannon, R.N.
• Marlon D Shelby, PA
• John Duncan Sherer, DMD, PA
• David Thomas Simpson, RPH
• South Carolina Center of Healing
• South Carolina CVS Pharmacy LLC (CVS Pharmacy #04386)

• Dentist in Chester, SC
• Providers in Chester, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.