Provider Demographics
NPI:1376380113
Name:GARTLEY, SHAMUS (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAMUS
Middle Name:
Last Name:GARTLEY
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 1:52 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-2331
Mailing Address - Country:US
Mailing Address - Phone:570-704-7404
Mailing Address - Fax:
Practice Address - Street 1:920 WYOMING AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-3999
Practice Address - Country:US
Practice Address - Phone:570-283-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0436391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics