Stephen K Shields, D.D.S.
Individual provider Active NPI Dentist · Cicero, IN
NPI 1063452274 · NPPES record last updated Feb 27, 2017
Key facts
- NPI
- 1063452274
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 12007382 (IN)
- Practice address
- 411 N Peru St
Cicero, IN 46034-9498 - Phone
- (317) 984-3531
- Fax
- (317) 984-8086
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12007382 | IN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cicero Family Dental LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12007382 | IN | Yes |
Addresses
Primary practice location
411 N Peru St
Cicero, IN 46034-9498
Mailing address
411 N Peru St
Cicero, IN 46034-9498
Phone (317) 984-3531
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100125360A | Medicaid | IN | |
| 20193 | Other | IN | DENTAL BENEFIT PROVIDERS |
| 779092 | Other | IN | UNITED CONCORDIA INSURANC |
Other providers in Cicero, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.