Individual
STEPHEN MARK SHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5690 MONROE ST, SYLVANIA, OH 43560-2736
(419) 479-3939
(419) 479-3933
Mailing address
5690 MONROE ST, STE A, SYLVANIA, OH 43560-2736
(419) 479-3939
(419) 479-3933
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
16634
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
30.016634
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0515599
—
OH
Enumeration date
06/15/2005
Last updated
08/01/2019
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