Provider Demographics
NPI:1417163833
Name:BATTLE-SIATITA, SHELRETHIA O'SHAY (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELRETHIA
Middle Name:O'SHAY
Last Name:BATTLE-SIATITA
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 1:1065 BOSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS AIR FORCE BASE
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-612-2657
Mailing Address - Fax:
Practice Address - Street 1:1065 BOSTON ROAD
Practice Address - Street 2:
Practice Address - City:ANDREWS AIR FORCE BASE
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-612-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23184122300000X
VA04014125261223P0300X
MD184001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics