Provider Demographics
NPI:1972317626
Name:SHIELDS OROFACIAL PAIN AND DENTAL SLEEP
Entity type:Organization
Organization Name:SHIELDS OROFACIAL PAIN AND DENTAL SLEEP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-351-5651
Mailing Address - Street 1:504 KEYWOOD CIR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3027
Mailing Address - Country:US
Mailing Address - Phone:601-351-5651
Mailing Address - Fax:601-351-9871
Practice Address - Street 1:504 KEYWOOD CIR STE A
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3027
Practice Address - Country:US
Practice Address - Phone:601-351-5651
Practice Address - Fax:601-351-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment