Provider Demographics
NPI:1528125242
Name:SHIELDS, ANDREW THOMAS III (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
Last Name:SHIELDS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:267 CAMINO VIEJO ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4818
Mailing Address - Country:US
Mailing Address - Phone:702-302-6449
Mailing Address - Fax:702-228-6452
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 508
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-228-8777
Practice Address - Fax:702-228-6452
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV46351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice