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General NPI Number Information
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NPI Number | 1346460649
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Entity Type | Organization
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Legal Business Name | SHEILD FAMILY DENTISTRY, S.C.
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 SUMMIT AVE SUITE 101
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City | OCONOMOWOC
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State | WI
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Zip | 53066
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Country | US
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Telephone | 262-567-1323
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Fax | 262-567-3422
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Provider Business Mailing Address
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Address Line | 1300 SUMMIT AVE SUITE 101
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City | OCONOMOWOC
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State | WI
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Zip | 53066
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Country | US
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Telephone | 262-567-1323
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Fax | 262-567-3422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER J SHEILD
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Credential | D.D.S.
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Telephone | 262-567-1323
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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 | 3477
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License Number State | WI
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