Provider Demographics
NPI:1366405839
Name:KEMPER, SHANNON SHACKLETTE (DMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:SHACKLETTE
Last Name:KEMPER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 CLAYS MILL RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3488
Mailing Address - Country:US
Mailing Address - Phone:859-224-3200
Mailing Address - Fax:859-219-1727
Practice Address - Street 1:3340 CLAYS MILL RD
Practice Address - Street 2:STE 2
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40803
Practice Address - Country:US
Practice Address - Phone:859-224-3200
Practice Address - Fax:859-219-1727
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist