Provider Demographics
NPI:1932240355
Name:SHIELDS, DOUGLAS FRASER (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:FRASER
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2685
Mailing Address - Country:US
Mailing Address - Phone:924-941-1763
Mailing Address - Fax:724-941-1769
Practice Address - Street 1:110 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2685
Practice Address - Country:US
Practice Address - Phone:924-941-1763
Practice Address - Fax:724-941-1769
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019724L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist