Provider Demographics
NPI:1578602124
Name:SHEARER, SHELLEY PAIGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:PAIGE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 BURLINGTON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1618
Mailing Address - Country:US
Mailing Address - Phone:859-647-7068
Mailing Address - Fax:859-647-7038
Practice Address - Street 1:6909 BURLINGTON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1618
Practice Address - Country:US
Practice Address - Phone:859-647-7068
Practice Address - Fax:859-647-7038
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY74151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60074150Medicaid