Healthcare Provider Details

I. General information

NPI: 1912390501
Provider Name (Legal Business Name): SHAVON BILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N ERIE ST 272
TOLEDO OH
43604-5317
US

IV. Provider business mailing address

635 N ERIE ST 272
TOLEDO OH
43604-5317
US

V. Phone/Fax

Practice location:
  • Phone: 419-213-4049
  • Fax: 419-213-4220
Mailing address:
  • Phone: 419-213-4049
  • Fax: 419-213-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31014140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: