Provider Demographics
NPI:1811351356
Name:REDMOND, SHONTERAL LAKAY (DDS)
Entity type:Individual
Prefix:DR
First Name:SHONTERAL
Middle Name:LAKAY
Last Name:REDMOND
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 1:97 1/2 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1115
Mailing Address - Country:US
Mailing Address - Phone:518-308-4200
Mailing Address - Fax:518-308-4300
Practice Address - Street 1:97 1/2 GEORGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12183-1115
Practice Address - Country:US
Practice Address - Phone:518-308-4200
Practice Address - Fax:518-308-4300
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0599241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice