Provider Demographics
NPI:1609014299
Name:SHIELDS, MARIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5 CHESHIRE PL
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2502
Mailing Address - Country:US
Mailing Address - Phone:631-261-3123
Mailing Address - Fax:
Practice Address - Street 1:5 CHESHIRE PL
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2502
Practice Address - Country:US
Practice Address - Phone:631-261-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039400-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice