Provider Demographics
NPI:1679900088
Name:SHIELDS, THOMAS C (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
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 1:7300 BLANCO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4936
Mailing Address - Country:US
Mailing Address - Phone:210-349-3745
Mailing Address - Fax:210-349-3898
Practice Address - Street 1:7300 BLANCO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4936
Practice Address - Country:US
Practice Address - Phone:210-349-3745
Practice Address - Fax:210-349-3898
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice