Provider Demographics
NPI:1376682138
Name:SHELINE, ROSEMARIE G (DDS)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:G
Last Name:SHELINE
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 1:110 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7710
Mailing Address - Country:US
Mailing Address - Phone:207-784-2211
Mailing Address - Fax:
Practice Address - Street 1:110 CANAL ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7710
Practice Address - Country:US
Practice Address - Phone:207-784-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4156122300000X
HIDT 2254122300000X
OH300322286122300000X
MD13862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist