Provider Demographics
NPI:1235452541
Name:SINGH, SHANTA WARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANTA
Middle Name:WARRIS
Last Name:SINGH
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 1:135 JENKINS ST
Mailing Address - Street 2:STE 105A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5176
Mailing Address - Country:US
Mailing Address - Phone:904-417-3291
Mailing Address - Fax:
Practice Address - Street 1:1081 A1A BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6733
Practice Address - Country:US
Practice Address - Phone:904-417-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice