Provider Demographics
NPI:1932440898
Name:SHIDELER DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SHIDELER DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHIDELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-462-7391
Mailing Address - Street 1:8 N GARFIELD
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 N GARFIELD
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120078981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty