Provider Demographics
NPI:1902800436
Name:SHUFFLEBARGER, STEVE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:D
Last Name:SHUFFLEBARGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 GRAND PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9593
Mailing Address - Country:US
Mailing Address - Phone:937-369-3069
Mailing Address - Fax:
Practice Address - Street 1:1850 GRAND PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9593
Practice Address - Country:US
Practice Address - Phone:937-369-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300210801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice