Provider Demographics
NPI:1285846618
Name:SHIRER, RENEE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:SHIRER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S 18TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1575
Mailing Address - Country:US
Mailing Address - Phone:765-538-3804
Mailing Address - Fax:765-742-7672
Practice Address - Street 1:709 S 18TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1575
Practice Address - Country:US
Practice Address - Phone:765-538-3804
Practice Address - Fax:765-742-7672
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010070B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice