Provider Demographics
NPI:1811251036
Name:SHETLER, LEANNA CHRISTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:CHRISTINE
Last Name:SHETLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEANNA
Other - Middle Name:CHRISTINE
Other - Last Name:ASSID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11 MAGNOLIA COVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-8905
Mailing Address - Country:US
Mailing Address - Phone:864-610-4485
Mailing Address - Fax:
Practice Address - Street 1:11 MAGNOLIA COVE DRIVE
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-2968
Practice Address - Country:US
Practice Address - Phone:864-610-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81841223P0221X
PADS0391991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry