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General NPI Number Information
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NPI Number | 1316288103
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Entity Type | Organization
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Legal Business Name | SHELHOUSE COMPREHENSIVE DENTAL LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 5335 FAR HILLS AVE STE 210
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City | DAYTON
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State | OH
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Zip | 45429-2317
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Country | US
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Telephone | 937-439-0275
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Fax | 937-439-0276
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Provider Business Mailing Address
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Address Line | 5335 FAR HILLS AVE STE 210
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City | DAYTON
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State | OH
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Zip | 45429-2317
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Country | US
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Telephone | 937-439-0275
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Fax | 937-439-0276
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAM A BROWN
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Credential |
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Telephone | 937-439-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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