Provider Demographics
NPI:1427524164
Name:LAIDIG, SHEILA KAY (LDH)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:KAY
Last Name:LAIDIG
Suffix:
Gender:F
Credentials:LDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15267 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9751
Mailing Address - Country:US
Mailing Address - Phone:574-993-8819
Mailing Address - Fax:
Practice Address - Street 1:2006 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5612
Practice Address - Country:US
Practice Address - Phone:574-259-8571
Practice Address - Fax:574-259-8632
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13002807A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist