Provider Demographics
NPI:1669486924
Name:SHAY, KRIS LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:LISA
Last Name:SHAY
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 1:7901 DOUGLAS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2451
Mailing Address - Country:US
Mailing Address - Phone:515-276-7800
Mailing Address - Fax:515-276-8400
Practice Address - Street 1:7901 DOUGLAS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2451
Practice Address - Country:US
Practice Address - Phone:515-276-7800
Practice Address - Fax:515-276-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0005470Medicaid