NPIMap

Organization Active NPI

Jeffrey J. Shambaugh DMD PC

Doing business as Shambaugh Dental Group

  • General Practice Dentistry
  • Fort Wayne, IN
National Provider Identifier
1568838225
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010642A Issued in IN
Legal business name
JEFFREY J. SHAMBAUGH DMD PC
Doing business as
Shambaugh Dental Group
Practice address
4341 Flagstaff CV
Fort Wayne, IN 46815-4400
Phone
(260) 493-2432
Fax
(260) 492-2942
NPI assigned
Aug 18, 2015
Last updated
Aug 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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

Authorized official

Name
Dr. Jeffrey Joseph Shambaugh, DMDNPI 1811080948
Title
Dentist/Owner
Phone
(260) 493-2432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12011943A IN
General Practice Dentistry 1223G0001X 12010642A IN Primary

Addresses

Primary practice location

4341 Flagstaff CV
Fort Wayne, IN 46815-4400

Mailing address

4341 Flagstaff CV
Fort Wayne, IN 46815-4400
Phone (260) 493-2432

Other names 1

  • Shambaugh Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

4341 Flagstaff Cv
Fort Wayne, IN 46815
Phone (260) 493-2432

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1568838225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4341 FLAGSTAFF CV",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154400",
            "telephone_number": "260-493-2432",
            "fax_number": "260-492-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 FLAGSTAFF CV",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154400",
            "telephone_number": "260-493-2432",
            "fax_number": "260-492-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY J. SHAMBAUGH DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "SHAMBAUGH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "260-493-2432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011943A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010642A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shambaugh Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; 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.