MEDICARE: STEPHEN PATRICK SHINKLE DMD

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	17259	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	311657400026	OTHER	CARE SOURCE
3	0007307	OTHER	DORAL AMERIGROUP

General Provider Information

NPI Number	:	1255316147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN PATRICK SHINKLE DMD

Provider Business Mailing Address
First Line	:	3020 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1710
Country	:	US
Telephone Number	:	513-531-0600
Fax Number	:	513-531-0600

Provider Business Practice Location Address
First Line	:	3020 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1710
Country	:	US
Telephone Number	:	513-531-0600
Fax Number	:	513-531-0600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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