Provider Demographics
NPI:1548510670
Name:DENZER, SHANNA LEE (RDH)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEE
Last Name:DENZER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-3720
Mailing Address - Country:US
Mailing Address - Phone:218-461-2628
Mailing Address - Fax:
Practice Address - Street 1:1313 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-4600
Practice Address - Country:US
Practice Address - Phone:218-206-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist