Provider Demographics
NPI:1629786561
Name:EASTON, SHEALIN MAURA SHEA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHEALIN
Middle Name:MAURA SHEA
Last Name:EASTON
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 1:1615 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1332
Mailing Address - Country:US
Mailing Address - Phone:248-835-9304
Mailing Address - Fax:
Practice Address - Street 1:13417 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2229
Practice Address - Country:US
Practice Address - Phone:734-245-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016015611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice