Provider Demographics
NPI:1366248221
Name:SHOULDERS, DEXTER
Entity type:Individual
Prefix:
First Name:DEXTER
Middle Name:
Last Name:SHOULDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7488 SANCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4923
Mailing Address - Country:US
Mailing Address - Phone:216-501-8200
Mailing Address - Fax:
Practice Address - Street 1:175 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2099
Practice Address - Country:US
Practice Address - Phone:216-501-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics