Most Relevant Information
Provider Data
| NPI Number: | 1003549122 |
| Provider Name: | SHANON BLACK DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 7631 |
Most Important Dates
| Enumeration Date: | 07/06/2022 |
| Last Updated: | 07/06/2022 |
Provider Practice Location
316 N MAIN ST STE 1
STILLWATER
OK
740755548
Practice Location Phone/Fax
| Phone: | 4053727474 |
| Fax: |
Provider Mailing Location
1208 S DUNCAN ST
STILLWATER
OK
740744427
Provider Mailing Phone/Fax
| Phone: | 7857668786 |
| Fax: |