Provider Demographics
NPI:1720267875
Name:S.R. SHIELDS, D.D.S.
Entity Type:Organization
Organization Name:S.R. SHIELDS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-782-3839
Mailing Address - Street 1:1325 W 16TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4496
Mailing Address - Country:US
Mailing Address - Phone:928-782-3839
Mailing Address - Fax:928-329-9029
Practice Address - Street 1:1325 W 16TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4496
Practice Address - Country:US
Practice Address - Phone:928-782-3839
Practice Address - Fax:928-329-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty