Healthcare Provider Details

I. General information

NPI: 1558713842
Provider Name (Legal Business Name): TIMOTHY O'SHEA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DRIVE MEDINN C213, SPC 5831
ANN ARBOR MI
48109-5831
US

IV. Provider business mailing address

1500 E. MEDICAL CENTER DRIVE MEDINN C213, SPC 5831
ANN ARBOR MI
48109-5831
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5950
  • Fax:
Mailing address:
  • Phone: 734-936-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021966
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: