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Deactivated NPI 1639240187 Deactivated / Inactive NPI Male Practitioner

Dr. Robert B. Shellworth , DDS

Dentist - General Practice • Boise, ID

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Robert Shellworth has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 13, 2006
NPI Deactivation Date January 25, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Robert Shellworth, DDS was a registered Dentist - General Practice practicing in Boise, ID. Throughout an active medical career spanning 17 years, Dr. Shellworth provided care at the practice location at 210 W MALLARD DR until profile deactivation on 2023-01-25.

Practice Location & Contact Primary Location

Practice Address

210 W Mallard Dr

Boise, ID 837066642

Telephone 2083869472
Fax 2083459590
Associated Practice Facility / Clinic
🏢 Jonathan W Bauter Dds Pllc Facility NPI 1427302843

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Boise, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.3 Yrs
Regional Practice Density
142 Specialists

Practicing in Boise, ID (781 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License ID D1511

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 25, 2023

Record deactivated on January 25, 2023

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 210 W MALLARD DR, BOISE, ID 837066642 (Tel: 2083869472)

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Updated Business Mailing Address July 08, 2007

Registered at 1814 EDGECLIFF TER, BOISE, ID 837022911 (Tel: 2083368018)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ROBERT SHELLWORTH, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #D1511 in ID)

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Initial NPI Registration & Enumeration November 13, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1639240187
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 13, 2006
Last Update: July 08, 2007
Deactivation Date: January 25, 2023

Mailing Address

1814 Edgecliff Ter

Boise, ID 837022911

Phone: 2083368018

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.