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Shannon Norman-Kotre

Dentist

Dental Providers

2240 S Huron Pkwy, Ann Arbor, MI 48104-5151

PECOS Enrollment

This provider is enrolled in PECOS as SHANNON NORMAN KOTRE.

Based on the most recent information from CMS, provider Shannon Norman-Kotre is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1073695326
Provider Type
Individual
Full Name
Norman-Kotre, Shannon
Credential
DDS

Gender
Female
Sole Proprietor
No
Enumeration Date
10/19/2006
Last Updated
7/8/2007

Contact Information

Practice Location

2240 S Huron Pkwy, Ann Arbor, MI 48104-5151

(734) 677-2156

(734) 677-2638

Mailing Location

2240 S Huron Pkwy, Ann Arbor, MI 48104-5151

(734) 677-2156

(734) 677-2638

Provider Taxonomies

Code	Description	License
Code 1223G0001X Primary	Description Dentist Dental Providers	License 2901017629 Michigan

Provider Identifiers

ID	Description	Issuer
ID 1382114	Description Other	Issuer CONCORDIA ID NUMBER Michigan
ID 17629	Description Other	Issuer PROVIDER ID NUMBER Michigan
ID D176290	Description Other	Issuer PROVIDER ID NUMBER Michigan

Shannon Norman-Kotre

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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Young, Fudah

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