Provider Demographics
NPI:1053385518
Name:BUNTING, SHANNON LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEA
Last Name:BUNTING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 MONROEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2618
Mailing Address - Country:US
Mailing Address - Phone:412-372-5516
Mailing Address - Fax:412-372-5760
Practice Address - Street 1:4106 MONROEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2618
Practice Address - Country:US
Practice Address - Phone:412-372-5516
Practice Address - Fax:412-372-5760
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice