Provider Demographics
NPI:1588004485
Name:DICKS, SHANA ASHLEY (DDS)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:ASHLEY
Last Name:DICKS
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 1:16900 SCIENCE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4465
Mailing Address - Country:US
Mailing Address - Phone:301-383-0958
Mailing Address - Fax:240-487-5161
Practice Address - Street 1:16900 SCIENCE DR STE 110
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4465
Practice Address - Country:US
Practice Address - Phone:301-383-0958
Practice Address - Fax:240-487-5161
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist