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General NPI Number Information
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NPI Number | 1649788688
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Entity Type | Organization
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Legal Business Name | SAMER G. SHAMOON, DDS, PC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 600 W 11 MILE RD
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City | BERKLEY
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State | MI
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Zip | 48072-3027
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Country | US
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Telephone | 248-543-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W 11 MILE RD
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City | BERKLEY
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State | MI
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Zip | 48072-3027
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Country | US
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Telephone | 248-543-1778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | TODAY'S SMILE CENTER P.C.
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Credential | DDS
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Telephone | 248-543-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 14187
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License Number State | MI
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