Provider Demographics
NPI:1285666354
Name:SHELLENBERGER, E. RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:RONALD
Last Name:SHELLENBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BRUMBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2801
Mailing Address - Country:US
Mailing Address - Phone:717-263-6060
Mailing Address - Fax:717-263-7190
Practice Address - Street 1:67 BRUMBAUGH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2801
Practice Address - Country:US
Practice Address - Phone:717-263-6060
Practice Address - Fax:717-263-7190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025778-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice