Provider Demographics
NPI:1861493033
Name:SIGUR, SHELLEY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:SIGUR
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 1:455 BARNARD ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4937
Mailing Address - Country:US
Mailing Address - Phone:615-400-0018
Mailing Address - Fax:
Practice Address - Street 1:429 N. DUVAL STREET
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417
Practice Address - Country:US
Practice Address - Phone:912-732-1011
Practice Address - Fax:912-732-1013
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-03-25
Deactivation Date:2019-07-01
Deactivation Code:
Reactivation Date:2019-07-19
Provider Licenses
StateLicense IDTaxonomies
TNDS69641223G0001X
AL6712-C1223G0001X
GADN012297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003239553AMedicaid
TN3205657Medicaid