Provider Demographics
NPI:1225256589
Name:DARE, SHEILA GAIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:GAIL
Last Name:DARE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:GAIL
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:106 3RD AVE SE
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-0669
Mailing Address - Country:US
Mailing Address - Phone:205-375-6314
Mailing Address - Fax:205-375-6314
Practice Address - Street 1:106 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481
Practice Address - Country:US
Practice Address - Phone:205-375-6314
Practice Address - Fax:205-375-6314
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-40740OtherBCBS NUMBER
AL4592OtherDENTAL LICENSE NUMBER