Provider Demographics
NPI:1063146397
Name:KIRTS, SHELBY (DDS)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:KIRTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2623 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4634
Mailing Address - Country:US
Mailing Address - Phone:765-413-6714
Mailing Address - Fax:
Practice Address - Street 1:2623 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4634
Practice Address - Country:US
Practice Address - Phone:765-413-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013833A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice