Provider Demographics
NPI:1518955566
Name:SHIELDS, IRIS LAMAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:LAMAE
Last Name:SHIELDS
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 1:4248 OVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4010
Mailing Address - Country:US
Mailing Address - Phone:410-491-9823
Mailing Address - Fax:410-638-0858
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE # 208
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:410-638-0858
Practice Address - Fax:410-638-0057
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001404400Medicaid