Provider Demographics
NPI:1699840116
Name:SHELHOUSE, ROBERT GREGORY (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GREGORY
Last Name:SHELHOUSE
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 1:5685 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2226
Mailing Address - Country:US
Mailing Address - Phone:937-435-5163
Mailing Address - Fax:937-291-9353
Practice Address - Street 1:5685 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2226
Practice Address - Country:US
Practice Address - Phone:937-435-5163
Practice Address - Fax:937-291-9353
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice