Provider Demographics
NPI:1710063433
Name:SHIALABBA, SAMUEL C JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:SHIALABBA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SENECA ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301
Mailing Address - Country:US
Mailing Address - Phone:814-677-3025
Mailing Address - Fax:814-677-6766
Practice Address - Street 1:45 SENECA ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301
Practice Address - Country:US
Practice Address - Phone:814-677-3025
Practice Address - Fax:814-677-6766
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA188171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice