Individual
JAMES A SHUPE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3030 LAKE AVE, SUITE 15, FORT WAYNE, IN 46805-5428
(260) 422-8419
(260) 422-3591
Mailing address
3030 LAKE AVE, SUITE 15, FORT WAYNE, IN 46805-5428
(260) 422-8419
(260) 422-3591
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12008822A
IN
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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