Provider Demographics
NPI:1346460649
Name:SHEILD FAMILY DENTISTRY, S.C.
Entity Type:Organization
Organization Name:SHEILD FAMILY DENTISTRY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEILD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-567-1323
Mailing Address - Street 1:1300 SUMMIT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066
Mailing Address - Country:US
Mailing Address - Phone:262-567-1323
Mailing Address - Fax:262-567-3422
Practice Address - Street 1:1300 SUMMIT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-567-1323
Practice Address - Fax:262-567-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty