Provider Demographics
NPI:1417356114
Name:DEAL, SHAYLA DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:DENISE
Last Name:DEAL
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 1:7611 S OSBORNE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4200
Mailing Address - Country:US
Mailing Address - Phone:301-780-7602
Mailing Address - Fax:301-780-7606
Practice Address - Street 1:7611 S OSBORNE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4200
Practice Address - Country:US
Practice Address - Phone:301-780-7602
Practice Address - Fax:301-780-7606
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist