Provider Demographics
NPI:1164565958
Name:SHEA, JOSEPH FREDERICK (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FREDERICK
Last Name:SHEA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3555 SUNSET OFFICE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1015
Mailing Address - Country:US
Mailing Address - Phone:314-822-9446
Mailing Address - Fax:
Practice Address - Street 1:3555 SUNSET OFFICE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1015
Practice Address - Country:US
Practice Address - Phone:314-822-9446
Practice Address - Fax:314-822-9448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics