Provider Demographics
NPI:1730105396
Name:LYKINS, SHAY DANIELS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:DANIELS
Last Name:LYKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 RIVER TER
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-5502
Mailing Address - Country:US
Mailing Address - Phone:706-698-3384
Mailing Address - Fax:706-698-3383
Practice Address - Street 1:78 RIVER TER
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5502
Practice Address - Country:US
Practice Address - Phone:706-698-3384
Practice Address - Fax:706-698-3383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000945865BMedicaid