Provider Demographics
NPI:1801910054
Name:HELM, SHAD RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHAD
Middle Name:RYAN
Last Name:HELM
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 1:2411 N TITLEIST WAY
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 E 10TH AVE
Practice Address - Street 2:SUITE #B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5125
Practice Address - Country:US
Practice Address - Phone:208-773-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice