Active NPI
Scott E Shipley, D.D.S.
- General Practice Dentistry
- Warsaw, IN
National Provider Identifier
1710106380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12009310
- Practice address
- 1904 E Center St
Warsaw, IN 46580-3701 - Phone
- (574) 376-4244
- Fax
- (574) 306-2711
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12009310 | IN | Primary |
Addresses
Primary practice location
1904 E Center St
Warsaw, IN 46580-3701
Mailing address
1904 E Center St
Warsaw, IN 46580-3701
Phone (574) 376-4244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351843855 | Other | IN | TAX IDENTIFICATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12009310 | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shipley Dental Innovations LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454371200000",
"number": "1710106380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1904 E CENTER ST",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803701",
"telephone_number": "574-376-4244",
"fax_number": "574-306-2711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1904 E CENTER ST",
"city": "WARSAW",
"state": "IN",
"postal_code": "465803701",
"telephone_number": "574-376-4244",
"fax_number": "574-306-2711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIPLEY",
"first_name": "SCOTT",
"middle_name": "E",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2016-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12009310",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION NUMBER",
"identifier": "351843855",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warsaw, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.