Individual provider Active NPI

Mark R Sheils, DDS

  • General Practice Dentistry
  • Fargo, ND
National Provider Identifier
1932243235
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1840 Issued in ND
Practice address
1300 Gateway Dr S
Fargo, ND 58103-3509
Phone
(701) 232-6683
NPI assigned
Feb 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1840 ND Primary

Addresses

Primary practice location

1300 Gateway Dr S
Fargo, ND 58103-3509

Mailing address

1300 Gateway Dr S
Fargo, ND 58103-3509
Phone (701) 232-6683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180307001143 ND Order and Referring Only - DentistPractitioner - Dentist 1658632666

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1840NDMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932243235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 GATEWAY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033509",
            "telephone_number": "701-232-6683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 GATEWAY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033509",
            "telephone_number": "701-232-6683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEILS",
        "first_name": "MARK",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "1840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.