Provider Demographics
NPI:1902963630
Name:SHIELDS, JENNIFER SUSAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUSAN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:702-302-2343
Mailing Address - Fax:702-228-6452
Practice Address - Street 1:600 WHITNEY RANCH DR
Practice Address - Street 2:SUITE 18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2611
Practice Address - Country:US
Practice Address - Phone:702-434-8686
Practice Address - Fax:702-456-5929
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV46361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice