Provider Demographics
NPI:1801907365
Name:HELMS, SHANE KRISTOFFER (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:KRISTOFFER
Last Name:HELMS
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 1:200 TELETECH DRIVE
Mailing Address - Street 2:BUILDING 1, SUITE A
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1423
Mailing Address - Country:US
Mailing Address - Phone:304-845-0809
Mailing Address - Fax:304-845-0499
Practice Address - Street 1:200 TELETECH DRIVE
Practice Address - Street 2:BUILDING 1, SUITE A
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1423
Practice Address - Country:US
Practice Address - Phone:304-845-0809
Practice Address - Fax:304-845-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2339919MedicaidOHIO MEDICAID NUMBER
WV2003313-000MedicaidWV MEDICAID NUMBER
1400654OtherUNITED CONCORDIA PROVIDER