Sam R. Shanlever, D.D.S.
Individual provider Active NPI General Practice Dentistry · Ratcliff, AR
NPI 1962598433 · NPPES record last updated Mar 2, 2010
Key facts
- NPI
- 1962598433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2285 (AR)
- Practice address
- 9755 W State Highway 22
Ratcliff, AR 72951-9000 - Phone
- (479) 635-5300
- Fax
- (479) 635-2010
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2285 | AR | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2285 | AR | Yes |
Addresses
Primary practice location
9755 W State Highway 22
Ratcliff, AR 72951-9000
Mailing address
PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 635-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103823608 | Medicaid | AR | |
| 846647 | Other | AR | UNITED CONCORDIA |
| 58898 | Other | AR | BLUE CROSS BLUE SHIELD |
Other providers in Ratcliff, AR
- River Valley Primary Care Services
- River Valley Primary Care Services Inc
- River Valley Primary Care Services Inc
- Peggy Rosson
- Sheridan Schneider
- Theodora L Short
- John C Urban
- Edward A Vela
All providers in Ratcliff, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.