Provider Demographics
NPI:1821270919
Name:SHIRER FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:SHIRER FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIRER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-742-4944
Mailing Address - Street 1:709 S 18TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1575
Mailing Address - Country:US
Mailing Address - Phone:765-742-4944
Mailing Address - Fax:765-742-7672
Practice Address - Street 1:709 S 18TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1575
Practice Address - Country:US
Practice Address - Phone:765-742-4944
Practice Address - Fax:765-742-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010070A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental