Healthcare Provider Details

I. General information

NPI: 1558772632
Provider Name (Legal Business Name): SHAHEERA AFZAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5139 W SAGINAW HWY
LANSING MI
48917-2635
US

IV. Provider business mailing address

3777 LONE PINE DR APT 1
HOLT MI
48842-7718
US

V. Phone/Fax

Practice location:
  • Phone: 517-940-6180
  • Fax:
Mailing address:
  • Phone: 248-730-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022189
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: