Healthcare Provider Details

I. General information

NPI: 1972317626
Provider Name (Legal Business Name): SHIELDS OROFACIAL PAIN AND DENTAL SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 KEYWOOD CIR STE A
FLOWOOD MS
39232-3027
US

IV. Provider business mailing address

504 KEYWOOD CIR STE A
FLOWOOD MS
39232-3027
US

V. Phone/Fax

Practice location:
  • Phone: 601-351-5651
  • Fax: 601-351-9871
Mailing address:
  • Phone: 601-351-5651
  • Fax: 601-351-9871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. WESLEY SHIELDS
Title or Position: OWNER
Credential: DMD
Phone: 601-351-5651