MEDICARE: ICARE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1518617612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE DENTAL

Provider Business Mailing Address
First Line	:	6148 MEADOWVIEW DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4750
Country	:	US
Telephone Number	:	313-918-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 WYOMING ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-1223
Country	:	US
Telephone Number	:	313-834-5000
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	YASER SHAHEEN
Credential	:
Telephone Number	:	313-918-5188

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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Directions to “ICARE DENTAL ” Practice Location

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