Provider Demographics
NPI:1215031448
Name:SHROYER, DOUGLAS S (DMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:SHROYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 RAILROAD AVE RT 48
Mailing Address - Street 2:P.O. BOX 376
Mailing Address - City:BLUE MOUND
Mailing Address - State:IL
Mailing Address - Zip Code:62513
Mailing Address - Country:US
Mailing Address - Phone:217-692-2097
Mailing Address - Fax:217-692-2102
Practice Address - Street 1:221 RAILROAD AVE RTE 48
Practice Address - Street 2:
Practice Address - City:BLUE MOUND
Practice Address - State:IL
Practice Address - Zip Code:62513
Practice Address - Country:US
Practice Address - Phone:217-692-2097
Practice Address - Fax:217-692-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice