Timothy J Shambaugh, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

127177 Issued in IN

Practice address

4606 D East State Blvd
Fort Wayne, IN 46815-6963

Phone

(260) 423-2340

Fax

(260) 422-5342

NPI assigned

Aug 9, 2006

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

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Oral & Maxillofacial Surgery Associates PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Wayne, IN
  • NPI 1831264324
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1124038260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4606 D EAST STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156963",
            "telephone_number": "260-423-2340",
            "fax_number": "260-422-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 D EAST STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156963",
            "telephone_number": "260-423-2340",
            "fax_number": "260-422-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMBAUGH",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "127177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200029030",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oluwatobi Shaleye
• Jeffrey Joseph Shambaugh, DMD
• Jennifer Shambaugh, NP
• Matthew E Shambaugh, MD
• Michael Eugene Shambaugh, DDS
• Mohdsyamir Shamsuddin
• Ariel A Shaneyfelt
• John Jacob Shank, DDS
• Margaret Kathryn Shank, LPN
• Rebecca Shank, RN

• Oral and Maxillofacial Surgery (Dentist) in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.