Healthcare Provider Details

I. General information

NPI: 1972553519
Provider Name (Legal Business Name): PHILIP R SHRINER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 PEACHTREE DR
GRAND LEDGE MI
48837-8967
US

IV. Provider business mailing address

6111 PEACHTREE DR
GRAND LEDGE MI
48837-8967
US

V. Phone/Fax

Practice location:
  • Phone: 517-622-8443
  • Fax: 517-622-4045
Mailing address:
  • Phone: 517-622-8443
  • Fax: 517-622-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901015885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: