# STEPHEN MARK SHALL

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1215932504
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 16634 | OH | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 30.016634 | OH | Yes |

## Other

- **Enumeration date:** 06/15/2005
- **Last updated:** 08/01/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0515599 | — | OH |