Michael Dean Shannon, D.S.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

1854 Issued in ND

Practice address

315 Main St S
Suite 302
Minot, ND 58701-3956

Phone

(701) 839-7288

Fax

(701) 839-1574

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982787024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S",
            "address_2": "SUITE 302",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-839-7288",
            "fax_number": "701-839-1574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MAIN ST S",
            "address_2": "SUITE 302",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587013956",
            "telephone_number": "701-839-7288",
            "fax_number": "701-839-1574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "MICHAEL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.S.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ND",
            "license": "1854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Sempeta, MD
• Serenity Therapeutic Equine Program
• Daniela Serrato
• Afsana Shaik, MD
• Lori A. Shaleen, PH.D.
• Rayanne F Shannon, DDS
• Angela Joy Shaw
• Avi Shaw, DO
• Lauren Shaw
• Mary Elizabeth Shaw, HIS

• Periodontics in Minot, ND
• Providers in Minot, ND by specialty
• Periodontics in North Dakota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.