MEDICARE: PETER J SHEMPP 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	122300000X	Dentist	16876	OH

General Provider Information

NPI Number	:	1043432818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER J SHEMPP DDS INC

Provider Business Mailing Address
First Line	:	3550 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2502
Country	:	US
Telephone Number	:	937-298-0908
Fax Number	:	937-298-3318

Provider Business Practice Location Address
First Line	:	3550 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2502
Country	:	US
Telephone Number	:	937-298-0908
Fax Number	:	937-298-3318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER J SHEMPP
Credential	:	DDS
Telephone Number	:	937-298-0908

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	10/23/2007

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