Provider Demographics
NPI:1639300668
Name:DOUGLASS, SHAMEIKA LAKAYYAI (RDA)
Entity Type:Individual
Prefix:MISS
First Name:SHAMEIKA
Middle Name:LAKAYYAI
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 N RANCHO AVE
Mailing Address - Street 2:H233
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6900
Mailing Address - Country:US
Mailing Address - Phone:909-885-0372
Mailing Address - Fax:909-885-0372
Practice Address - Street 1:12121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1123
Practice Address - Country:US
Practice Address - Phone:310-820-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73858126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant