Provider Demographics
NPI:1205012226
Name:SHELLEY SHEARER DMD PLLC
Entity Type:Organization
Organization Name:SHELLEY SHEARER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-647-7068
Mailing Address - Street 1:6909 BURLINGTON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1618
Mailing Address - Country:US
Mailing Address - Phone:859-647-7068
Mailing Address - Fax:859-647-7038
Practice Address - Street 1:6909 BURLINGTON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1618
Practice Address - Country:US
Practice Address - Phone:859-647-7068
Practice Address - Fax:859-647-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74151223G0001X
KY84751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty