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Individual

MICHAEL RICHARD SHELESTAK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
3115 MAIN ST, WEST MIDDLESEX, PA 16159-3411
(724) 528-1515
(724) 528-0217
Mailing address
PO BOX 636896, CINCINNATI, OH 45263-6896
(330) 884-7158
(330) 884-7175

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
DS040096
PA
1223G0001X
General Practice Dentistry
Primary
30024581
OH
1223G0001X
General Practice Dentistry
FS4701428
PA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
06/11/2014
Last updated
04/09/2021
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