Provider Demographics
NPI:1861694762
Name:SPINA, SHANNA LEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:LEIGH
Last Name:SPINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:195 N. ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089
Mailing Address - Country:US
Mailing Address - Phone:847-215-1511
Mailing Address - Fax:847-243-0509
Practice Address - Street 1:MORRIS DENTAL SOLUTIONS
Practice Address - Street 2:195 N. ARLINGTON HEIGHTS RD. SUITE 160
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-215-1511
Practice Address - Fax:847-243-0509
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0249401223G0001X
IL0190249401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice