Provider Demographics
NPI:1740055847
Name:EASTON, MAURA ERIN SHEA (DDS)
Entity type:Individual
Prefix:DR
First Name:MAURA
Middle Name:ERIN SHEA
Last Name:EASTON
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 1:625 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1917
Mailing Address - Country:US
Mailing Address - Phone:248-794-5164
Mailing Address - Fax:
Practice Address - Street 1:1105 SEDGWICK ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3339
Practice Address - Country:US
Practice Address - Phone:810-984-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016019651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice