Provider Demographics
NPI:1093506669
Name:EIBERGER, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:EIBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N ALANTHUS AVE
Mailing Address - Street 2:
Mailing Address - City:STANBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:64489-1417
Mailing Address - Country:US
Mailing Address - Phone:660-822-1082
Mailing Address - Fax:
Practice Address - Street 1:3524 US HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-8210
Practice Address - Country:US
Practice Address - Phone:660-822-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046222124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist