Provider Demographics
NPI:1568547016
Name:SHIELDS, THOMAS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:SHIELDS
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 1:2333 N TRIPHAMMER RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1082
Mailing Address - Country:US
Mailing Address - Phone:607-257-0078
Mailing Address - Fax:607-266-7815
Practice Address - Street 1:2333 N TRIPHAMMER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1082
Practice Address - Country:US
Practice Address - Phone:607-257-0078
Practice Address - Fax:607-266-7815
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1106131OtherTAX ID NUMBER