Healthcare Provider Details

I. General information

NPI: 1225527732
Provider Name (Legal Business Name): SHELBY ROHR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E MAIN ST
NEW LONDON OH
44851-1233
US

IV. Provider business mailing address

286 STATE ROUTE 511
NOVA OH
44859-9707
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1544
  • Fax:
Mailing address:
  • Phone: 419-606-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025390
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025390
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: