Provider Demographics
NPI:1942931506
Name:DASH, SHAREKIA (MA)
Entity Type:Individual
Prefix:
First Name:SHAREKIA
Middle Name:
Last Name:DASH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CONCORD TERRANCE
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252
Mailing Address - Country:US
Mailing Address - Phone:470-483-2992
Mailing Address - Fax:
Practice Address - Street 1:901 SUMMERS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4931
Practice Address - Country:US
Practice Address - Phone:470-483-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician