Provider Demographics
NPI:1174530836
Name:OBERNUEFEMANN, SHANNON SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SCOTT
Last Name:OBERNUEFEMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1651
Mailing Address - Country:US
Mailing Address - Phone:602-242-1729
Mailing Address - Fax:
Practice Address - Street 1:777 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1651
Practice Address - Country:US
Practice Address - Phone:602-242-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist