Provider Demographics
NPI:1326663139
Name:LICHTEN, SHAYNA BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:BETH
Last Name:LICHTEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:BETH
Other - Last Name:CRANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3125 S ORM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3742
Mailing Address - Country:US
Mailing Address - Phone:612-735-3333
Mailing Address - Fax:
Practice Address - Street 1:111 W WIGWAM BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4636
Practice Address - Country:US
Practice Address - Phone:623-935-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist