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Individual
STEPHEN MARK SHALL
Active
Individual
STEPHEN MARK SHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
16634
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
30.016634
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0515599
—
OH
Enumeration date
06/15/2005
Last updated
08/01/2019
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