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General NPI Number Information
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NPI Number | 1164565958
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Entity Type | Individual
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Provider Name | JOSEPH FREDERICK SHEA DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2800 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-4742
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Country | US
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Telephone | 618-474-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 325 PARK AVE
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City | KIRKWOOD
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State | MO
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Zip | 63122-4651
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Country | US
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Telephone | 314-952-0366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 019022726
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License Number State | IL
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