=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437585627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUIS A SHAHEEN D.D.S., PLC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2013
-----------------------------------------------------
Last Update Date | 09/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | G9171 NORTH SAGINAW ST.
-----------------------------------------------------
City | MT. MORRIS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-687-3010
-----------------------------------------------------
Fax | 810-687-1228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | G9171 NORTH SAGINAW ST. P.O. BOX 247
-----------------------------------------------------
City | MT. MORRIS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-687-3010
-----------------------------------------------------
Fax | 810-687-1228
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 014184
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------