Mark T Shehan, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4949 Issued in NC

Practice address

1601 South Hawthorne Road
Winston Salem, NC 27103-4127

Phone

(336) 765-9550

Fax

(336) 765-9552

NPI assigned

Aug 24, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Smith & Russell DDS PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Winston Salem, NC
  • NPI 1649963042
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083721906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SOUTH HAWTHORNE ROAD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034127",
            "telephone_number": "336-765-9550",
            "fax_number": "336-765-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SOUTH HAWTHORNE ROAD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034127",
            "telephone_number": "336-765-9550",
            "fax_number": "336-765-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEHAN",
        "first_name": "MARK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "4949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7997761",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Norman Sheets, PA
• Alexandra Cella Shefferly, PA-C
• Kevin James Shefferly, MMS IN PA STUDIES
• Jamehl Demons Shegog, MD
• Joan L. Shehan, RDH
• Amira Shehata, RD, LD
• Hiba Ikram Sheikh, MD
• Shekinah Resource Foundation
• David M Shelburne, MD
• Tiffini Anne Sheldon-Morris, PSY.D.

• Oral and Maxillofacial Surgery (Dentist) in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.