Professional Dental Associates LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ASSOCIATES LLC

Practice address

615 W Macphail Rd Ste 208
Bel Air, MD 21014-4469

Phone

(410) 638-0858

Fax

(410) 638-0057

NPI assigned

Apr 12, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Iris Shields, DDSNPI 1518955566

Title

Owner/Dentist

Phone

(410) 638-0858

Specialties & licenses 1

Addresses

Other names 1

• Professional Dental Associates LLC Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Iris Lamae Shields, D.D.S.

  • General Practice Dentistry
  • Bel Air, MD
  • NPI 1518955566
  NPD Authorized official

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

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1184366866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W MACPHAIL RD STE 208",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144469",
            "telephone_number": "410-638-0858",
            "fax_number": "410-638-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W MACPHAIL RD STE 208",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144469",
            "telephone_number": "410-638-0858",
            "fax_number": "410-638-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-12",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "410-638-0858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Dental Associates LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Erin Prokop, C.F.N.P.
• Clinton David Protack, MD
• Lisa Proutt, PT

• General Practice Dentistry in Bel Air, MD
• Providers in Bel Air, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.