Active NPI
Michael W Shenk, DDS
- General Practice Dentistry
- Roswell, GA
National Provider Identifier
1881781128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN009014
- Practice address
- 4690 Woodstock Rd
Suite 100
Roswell, GA 30075 - Phone
- (770) 992-6568
- Fax
- (770) 992-9520
- NPI assigned
- Oct 6, 2006
- 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 | DN009014 | GA | Primary |
Addresses
Primary practice location
4690 Woodstock Rd
Suite 100
Roswell, GA 30075
Mailing address
4690 Woodstock Rd
Suite 100
Roswell, GA 30075
Phone (770) 992-6568
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 |
|---|---|---|---|
| DN009014 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael W. Shenk D.D.S. P.C. | General Practice | 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.
-
- General Practice Dentistry
- Roswell, GA
- NPI 1619074291
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881781128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4690 WOODSTOCK RD",
"address_2": "SUITE 100",
"city": "ROSWELL",
"state": "GA",
"postal_code": "30075",
"telephone_number": "770-992-6568",
"fax_number": "770-992-9520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4690 WOODSTOCK RD",
"address_2": "SUITE 100",
"city": "ROSWELL",
"state": "GA",
"postal_code": "30075",
"telephone_number": "770-992-6568",
"fax_number": "770-992-9520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHENK",
"first_name": "MICHAEL",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN009014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.