Healthcare Provider Details

I. General information

NPI: 1972095032
Provider Name (Legal Business Name): MASHINI DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 M 139
BENTON HARBOR MI
49022
US

IV. Provider business mailing address

PO BOX 70887
CLEVELAND OH
44190-0887
US

V. Phone/Fax

Practice location:
  • Phone: 239-487-3139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MASHINI
Title or Position: OWNER
Credential:
Phone: 269-487-3139