Michael Harold Shields, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2033-83 Issued in MS

Practice address

4218 Castenera Ave
Moss Point, MS 39563-2719

Phone

(228) 475-5854

Fax

(228) 475-0287

NPI assigned

Apr 5, 2007

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1649392085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 CASTENERA AVE",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395632719",
            "telephone_number": "228-475-5854",
            "fax_number": "228-475-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4218 CASTENERA AVE",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395632719",
            "telephone_number": "228-475-5854",
            "fax_number": "228-475-0287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "MICHAEL",
        "middle_name": "HAROLD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-05",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2033-83",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00060001",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Moss Point, MS
• Providers in Moss Point, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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.