Provider Demographics
NPI:1770996696
Name:SHAIA, CRYSTEL (DDS)
Entity type:Individual
Prefix:
First Name:CRYSTEL
Middle Name:
Last Name:SHAIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CRYSTEL
Other - Middle Name:
Other - Last Name:SALAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6500 PEARL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3813
Mailing Address - Country:US
Mailing Address - Phone:440-884-9898
Mailing Address - Fax:
Practice Address - Street 1:6500 PEARL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3813
Practice Address - Country:US
Practice Address - Phone:440-884-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist