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NPI Code Detail

MEDICARE: DR. ANN C. SHACKELFORD DDS

MEDICARE: DR. ANN C. SHACKELFORD DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry30.024594OH
21223G0001XGeneral Practice Dentistry12010096IN
31223G0001XGeneral Practice Dentistry9730KY

General Provider Information

NPI Number : 1942429022
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANN C. SHACKELFORD DDS
Provider Business Mailing Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number :
Provider Business Practice Location Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number : 859-655-6186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2007
Last Update Date : 08/16/2023

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