Individual
STEPHEN K SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
411 N PERU ST, CICERO, IN 46034-9498
(317) 984-3531
(317) 984-8086
Mailing address
411 N PERU ST, CICERO, IN 46034-9498
(317) 984-3531
(317) 984-8086
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007382
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100125360A
—
IN
01
—
20193
DENTAL BENEFIT PROVIDERS
IN
01
—
779092
UNITED CONCORDIA INSURANC
IN
Enumeration date
06/07/2006
Last updated
02/27/2017
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