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General NPI Number Information
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NPI Number | 1811251036
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Entity Type | Individual
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Provider Name | LEANNA CHRISTINE SHETLER D.M.D
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Gender | Female
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 11 MAGNOLIA COVE DRIVE
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-2968
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Country | US
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Telephone | 864-610-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MAGNOLIA COVE DRIVE
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-8905
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Country | US
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Telephone | 864-610-4485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8184
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS039199
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License Number State | PA
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