Provider Demographics
NPI:1477762532
Name:RIDENOUR, SHELLEY MAE (DDS MS)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MAE
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 HIGHGATE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-888-1893
Mailing Address - Fax:
Practice Address - Street 1:6649 N HIGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4070
Practice Address - Country:US
Practice Address - Phone:614-846-3636
Practice Address - Fax:614-846-3656
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300191391223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics