Provider Demographics
NPI:1770869877
Name:SHIMELES, LAELAYE B (DDS)
Entity type:Individual
Prefix:DR
First Name:LAELAYE
Middle Name:B
Last Name:SHIMELES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13806 GULLIVERS TRL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5329
Mailing Address - Country:US
Mailing Address - Phone:301-693-4896
Mailing Address - Fax:
Practice Address - Street 1:7878 GATEWAY BLVD E
Practice Address - Street 2:STE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1838
Practice Address - Country:US
Practice Address - Phone:915-595-1200
Practice Address - Fax:915-595-0400
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14374122300000X
TX274801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist