MEDICARE: SHAWN A DORNHECKER DDS & JESAL A PATEL DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30021008 &30021009	OH

General Provider Information

NPI Number	:	1033200860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAWN A DORNHECKER DDS & JESAL A PATEL DDS INC

Provider Business Mailing Address
First Line	:	3500 SIARON WAY
Second Line	:
City	:	FAIRFIELD TWP
State	:	OH
Zip	:	45011
Country	:	US
Telephone Number	:	513-815-3166
Fax Number	:	513-829-5499

Provider Business Practice Location Address
First Line	:	3500 SIARON WAY
Second Line	:
City	:	FAIRFIELD TWP
State	:	OH
Zip	:	45011
Country	:	US
Telephone Number	:	513-815-3166
Fax Number	:	513-829-5499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAWN A DORNHECKER
Credential	:	DDS
Telephone Number	:	513-518-2463

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/24/2020

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