Healthcare Provider Details

I. General information

NPI: 1417432899
Provider Name (Legal Business Name): SHELBY STEIN SHEERAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 BEAUMONT CENTRE CIR STE 200
LEXINGTON KY
40513-1956
US

IV. Provider business mailing address

5089 SULPHUR LN
LEXINGTON KY
40509-8427
US

V. Phone/Fax

Practice location:
  • Phone: 859-296-4846
  • Fax:
Mailing address:
  • Phone: 270-769-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10115
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10115
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: