Shannon Elisa Wood, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009892A Issued in IN

Practice address

517 E 5TH St
Huntingburg, IN 47542-1004

Phone

(812) 683-4100

Fax

(812) 683-4110

NPI assigned

Feb 6, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

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.

• Huntinburg Family Dentistry

  • Dentist
  • Huntingburg, IN
  • NPI 1861833147
  NPD (past) Authorized official
• Huntingburg Family Dentistry

  • Dental Clinic/Center
  • Huntingburg, IN
  • NPI 1417310566
  NPD (past)

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

{
    "created_epoch": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360108800000",
    "number": "1235478587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 E 5TH ST",
            "city": "HUNTINGBURG",
            "state": "IN",
            "postal_code": "475421004",
            "telephone_number": "812-683-4100",
            "fax_number": "812-683-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 E 5TH ST",
            "city": "HUNTINGBURG",
            "state": "IN",
            "postal_code": "475421004",
            "telephone_number": "812-683-4100",
            "fax_number": "812-683-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "SHANNON",
        "middle_name": "ELISA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2013-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009892A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian M Wagner, DDS
• Lee B Walden, DC
• Michael G Warren, DDS
• Wellness Center of Indiana LLC
• Samantha Wendholt, PHARMD

• General Practice Dentistry in Huntingburg, IN
• Providers in Huntingburg, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; 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.