Provider Demographics
NPI:1538237201
Name:SHOLAR, JANE YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:YOUNG
Last Name:SHOLAR
Suffix:
Gender:F
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:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-1395
Mailing Address - Country:US
Mailing Address - Phone:704-664-5539
Mailing Address - Fax:704-664-6983
Practice Address - Street 1:252 W MCLELLAND AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3133
Practice Address - Country:US
Practice Address - Phone:704-664-5539
Practice Address - Fax:704-664-6983
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997777Medicaid
NC8997777Medicaid