Provider Demographics
NPI:1609564103
Name:THIBODEAU, SHANNON MURPHY (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MURPHY
Last Name:THIBODEAU
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 1:29292 SW TOWN CENTER LOOP E STE A
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9491
Mailing Address - Country:US
Mailing Address - Phone:503-682-0431
Mailing Address - Fax:
Practice Address - Street 1:29292 SW TOWN CENTER LOOP E STE A
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9491
Practice Address - Country:US
Practice Address - Phone:503-682-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist