Dr Shannon Kelly Blair, DDS is a medicare enrolled "Dentist - General Practice" provider in Penasco, New Mexico. She went to Howard University College Of Dentistry and graduated in 2020 and has 6 years of diverse experience with area of expertise as Dentist. Her current practice location is
201 K-2 Buffalo Trail, Penasco, New Mexico. You can reach out to her office (for appointments etc.) via phone at
(575) 251-8010.
Dr Shannon Kelly Blair is licensed to practice in New Mexico (license number DD22013) and she also participates in the medicare program. She
may accept medicare assignments (which means she may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and her NPI Number is 1841823143.
Healthcare Provider's Profile
| Full Name | Dr Shannon Kelly Blair |
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| Gender | Female |
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| Speciality | Dentist |
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| Experience | 6 Years |
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| Location | 201 K-2 Buffalo Trail, Penasco, New Mexico |
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| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Dr Shannon Kelly Blair attended and graduated from Howard University College Of Dentistry in 2020
NPI Data:
- NPI Number: 1841823143
- Provider Enumeration Date: 02/15/2020
- Last Update Date: 02/03/2026
Medicare PECOS Information:
- PECOS PAC ID: 3476973165
- Enrollment ID: I20260529001561
Medical Identifiers
Medical identifiers for Dr Shannon Kelly Blair such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1841823143 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 1223G0001X | Dentist - General Practice | DDS106783 (California) | Secondary |
| 1223G0001X | Dentist - General Practice | DD22013 (New Mexico) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Shannon Kelly Blair is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Dr Shannon Kelly Blair, DDS Po Box 127, Penasco, NM 87553-0127 Ph: (575) 251-8010 | Dr Shannon Kelly Blair, DDS 201 K-2 Buffalo Trail, Penasco, NM 87553 Ph: (575) 251-8010 |
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