Shambaugh, Timothy J
Shambaugh, Timothy J is an individual health care provider with primary practice located at 4606 D East State Blvd , Fort Wayne IN 46815-6963. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Shambaugh, Timothy J can be contacted via phone (260) 423-2340.Contact Information
Primary practice address
4606 D East State Blvd
Fort Wayne IN 46815-6963
Phone: (260) 423-2340
Fax: (260) 422-5342
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 127177 | Indiana |
Profile Details
| NPI number | 1124038260 |
|---|---|
| LBN Legal business name | Shambaugh, Timothy J |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 9th, 2006 |
| Last updated | Jul 1st, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124038260 | NPPES |
| Indiana | MEDICAID | 200029030 |
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