# SHAKAMAK FAMILY DENTISTRY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shakamak Family Dentistry, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568992022
- **Authorized official:** DR. STEVEN W KELLETT DDS (OWNER)
- **Authorized official phone:** (812) 665-2275

## Contact information

- **Practice address:** 206 S MERIDIAN ST, JASONVILLE, IN 47438-1520
- **Practice address phone:** (812) 665-2275
- **Practice address fax:** (812) 665-9374
- **Mailing address:** 190 C ST NW, LINTON, IN 47441-1328
- **Mailing address phone:** (812) 847-8646
- **Mailing address fax:** (812) 847-8761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12012106A | IN | Yes |

## Other

- **Enumeration date:** 06/18/2017
- **Last updated:** 06/18/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 201234800A | — | IN |