Provider Demographics
NPI:1841303773
Name:THOMAS C SHIELDS DDS PA
Entity type:Organization
Organization Name:THOMAS C SHIELDS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-349-3745
Mailing Address - Street 1:7300 BLANCO RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4938
Mailing Address - Country:US
Mailing Address - Phone:210-349-3745
Mailing Address - Fax:210-349-3898
Practice Address - Street 1:7300 BLANCO RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4938
Practice Address - Country:US
Practice Address - Phone:210-349-3745
Practice Address - Fax:210-349-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty