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Individual

STEPHEN K SHIELDS

Active
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Individual

STEPHEN K SHIELDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007382
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100125360A
—
IN
01
—
20193
DENTAL BENEFIT PROVIDERS
IN
01
—
779092
UNITED CONCORDIA INSURANC
IN
Enumeration date
06/07/2006
Last updated
02/27/2017
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