Active NPI
Jennifer Susan Shields, DMD
- General Practice Dentistry
- Henderson, NV
National Provider Identifier
1902963630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4636
- Practice address
- 600 Whitney Ranch Dr
Suite 18
Henderson, NV 89014-2611 - Phone
- (702) 434-8686
- Fax
- (702) 456-5929
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- 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 | 4636 | NV | Primary |
Addresses
Primary practice location
600 Whitney Ranch Dr
Suite 18
Henderson, NV 89014-2611
Mailing address
267 Camino Viejo St
Henderson, NV 89012-4818
Phone (702) 302-2343
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 |
|---|---|---|---|
| 4636 | NV | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902963630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "267 CAMINO VIEJO ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890124818",
"telephone_number": "702-302-2343",
"fax_number": "702-228-6452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 WHITNEY RANCH DR",
"address_2": "SUITE 18",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890142611",
"telephone_number": "702-434-8686",
"fax_number": "702-456-5929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "JENNIFER",
"middle_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "4636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
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.