Provider Demographics
NPI:1548255995
Name:SHEA, DANIEL ROBINETT (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBINETT
Last Name:SHEA
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 1:1930 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1483
Mailing Address - Country:US
Mailing Address - Phone:225-344-0391
Mailing Address - Fax:225-389-9324
Practice Address - Street 1:1930 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-1483
Practice Address - Country:US
Practice Address - Phone:225-344-0391
Practice Address - Fax:225-389-9324
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice