# JEFFREY J. SHAMBAUGH DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shambaugh Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568838225
- **Authorized official:** DR. JEFFREY JOSEPH SHAMBAUGH DMD (DENTIST/OWNER)
- **Authorized official phone:** (260) 493-2432

## Contact information

- **Practice address:** 4341 FLAGSTAFF CV, FORT WAYNE, IN 46815-4400
- **Practice address phone:** (260) 493-2432
- **Practice address fax:** (260) 492-2942
- **Mailing address:** 4341 FLAGSTAFF CV, FORT WAYNE, IN 46815-4400
- **Mailing address phone:** (260) 493-2432
- **Mailing address fax:** (260) 492-2942

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12010642A | IN | Yes |
| 1223G0001X | General Practice Dentistry | 12011943A | IN | — |

## Other

- **Enumeration date:** 08/18/2015
- **Last updated:** 08/18/2015