Provider Demographics
NPI:1932267424
Name:SHIDELER, WILLIAM MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MARK
Last Name:SHIDELER
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 1:8 NORTH GARFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5019
Mailing Address - Country:US
Mailing Address - Phone:219-462-7391
Mailing Address - Fax:219-464-0262
Practice Address - Street 1:8 NORTH GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5019
Practice Address - Country:US
Practice Address - Phone:219-462-7391
Practice Address - Fax:219-464-0262
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007898A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice