| Doctor Name: | SHANNON GRYSKWICZ |
| NPI Number: | 1780001735 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5007 |
| Business Practice Address: | 178 Cape Rd Standish, ME - 040846147 |
| Business Phone Number: | 2076422310 |
| Business Fax Number: | 2076426815 |
| Mailing Address: | Po Box 549, STANDISH |
| State: | ME |
| Postal Code: | 040840549 |
| Phone Number: | 2076422310 |
| Fax Number: | 2076426815 |
| NPI Enumeration Date: | 03/27/2014 |
| NPI Last Update Date: | 03/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | 5007 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |