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General NPI Number Information
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NPI Number | 1811364599
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Entity Type | Individual
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Provider Name | NICHOLAS SHIREY DMD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 9416 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-4157
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Country | US
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Telephone | 734-455-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 MALLARD COVE DR
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City | ANN ARBOR
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State | MI
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Zip | 48108-9503
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Country | US
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Telephone | 717-965-6067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901022928
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License Number State | MI
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