Provider Demographics
NPI:1215641535
Name:VAN BUREN DENTAL
Entity type:Organization
Organization Name:VAN BUREN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEPLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-253-9115
Mailing Address - Street 1:1950 S SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1446
Mailing Address - Country:US
Mailing Address - Phone:937-253-9115
Mailing Address - Fax:937-253-3976
Practice Address - Street 1:1950 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1446
Practice Address - Country:US
Practice Address - Phone:937-253-9115
Practice Address - Fax:937-253-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty