Provider Demographics
NPI:1831716448
Name:ROSZHART, SHELBY (DDS)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ROSZHART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 HIGH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3112
Mailing Address - Country:US
Mailing Address - Phone:515-244-9565
Mailing Address - Fax:888-566-2377
Practice Address - Street 1:1540 HIGH ST STE 201
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3112
Practice Address - Country:US
Practice Address - Phone:515-244-9565
Practice Address - Fax:888-566-2377
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09793261QD0000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty