Shaun Patrick Doherty, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21964 Issued in OH

Practice address

711 Lincoln Way E
Massillon, OH 44646-6829

Phone

(330) 833-4746

Fax

(330) 832-9928

NPI assigned

Jul 8, 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

Medicare fee-for-service enrollment

Enrolled in OH

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.

• Doherty DDS, and Paulus DDS LLC

  • General Practice Dentistry
  • Massillon, OH
  • NPI 1306149430
  NPD (past)
• J. Douglas Paulus D.D.S. Inc.

  • Dentist
  • Massillon, OH
  • NPI 1457434755
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447283056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 EDINBURG AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447081159",
            "telephone_number": "330-479-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 LINCOLN WAY E",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446466829",
            "telephone_number": "330-833-4746",
            "fax_number": "330-832-9928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "SHAUN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "21964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Michael Doan
• Lilybeth Contreras Dobran, COTA
• Doctors Hospital Physician Services LLC
• Kelsey Ann Doering, OD
• Doherty DDS, and Paulus DDS LLC
• Robert Lee Doidge, R.PH.
• Brian J Dooley, PTA
• Cynthia Dorety
• Lisa Renee Dorland, LPCC-S, LSW
• Faith Dotson

• General Practice Dentistry in Massillon, OH
• Providers in Massillon, OH by specialty
• General Practice Dentistry in Ohio

• 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.