Healthcare Provider Details

I. General information

NPI: 1023717865
Provider Name (Legal Business Name): OLIVIA RUTH SHINGLEDECKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PINNACLE DR
CLARION PA
16214-3800
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 814-223-9906
  • Fax:
Mailing address:
  • Phone: 814-223-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH073322
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH001343
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: