Provider Demographics
NPI:1467493064
Name:SHAH, SHEILA K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 FORSYTH RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4401
Mailing Address - Country:US
Mailing Address - Phone:478-757-8714
Mailing Address - Fax:478-757-0253
Practice Address - Street 1:4929 FORSYTH RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4401
Practice Address - Country:US
Practice Address - Phone:478-757-8714
Practice Address - Fax:478-757-0253
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice