Provider Demographics
NPI:1528471307
Name:ANTHONY SHAIA
Entity type:Organization
Organization Name:ANTHONY SHAIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-884-9898
Mailing Address - Street 1:6500 PEARL RD STE 100
Mailing Address - Street 2:
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:440-884-9030
Practice Address - Street 1:6500 PEARL RD STE 100
Practice Address - Street 2:
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:440-884-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0095753Medicaid