Provider Demographics
NPI:1033905914
Name:MCTAGGART, SHANNON BROOKE (DMD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BROOKE
Last Name:MCTAGGART
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 NORLAND DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4960
Mailing Address - Country:US
Mailing Address - Phone:484-888-2197
Mailing Address - Fax:
Practice Address - Street 1:418 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3101
Practice Address - Country:US
Practice Address - Phone:201-499-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program