Healthcare Provider Details

I. General information

NPI: 1164565958
Provider Name (Legal Business Name): JOSEPH FREDERICK SHEA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 COLLEGE AVE
ALTON IL
62002-4742
US

IV. Provider business mailing address

325 PARK AVE
KIRKWOOD MO
63122-4651
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-7000
  • Fax:
Mailing address:
  • Phone: 314-952-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019022726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: