Individual
DR. GEORGE BRYAN SHUPING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
438 WILLIAMSON RD, MOORESVILLE, NC 28117-9185
(704) 664-3636
Mailing address
111 HARBOR SHORE CT, MOORESVILLE, NC 28117-8911
(704) 663-1138
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
6509
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6509
LICENSE #
NC
05
—
8990128
—
NC
01
—
902F1
BCBS PROVIDER #
NC
Enumeration date
01/10/2007
Last updated
07/08/2007
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