Provider Demographics
NPI:1821367756
Name:JOHN SHEA LAIR, D.M.D., PLLC
Entity Type:Organization
Organization Name:JOHN SHEA LAIR, D.M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:LAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-365-7803
Mailing Address - Street 1:603 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1248
Mailing Address - Country:US
Mailing Address - Phone:606-365-7803
Mailing Address - Fax:606-365-1070
Practice Address - Street 1:603 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1248
Practice Address - Country:US
Practice Address - Phone:606-365-7803
Practice Address - Fax:606-365-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60056876Medicaid