Individual
SAMANTHA K SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 HUDSON ST, ELKHART, IN 46516-2023
(574) 522-6702
Mailing address
1400 HUDSON ST, ELKHART, IN 46516-2023
(574) 522-6702
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13007572A
IN
Other
Enumeration date
04/28/2022
Last updated
04/28/2022
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