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General NPI Number Information
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NPI Number | 1841086584
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Entity Type | Organization
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Legal Business Name | SHELBY GRACE DENTAL PLLC
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 47100 SCHOENHERR RD STE A
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-4714
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Country | US
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Telephone | 586-566-8338
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Fax |
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Provider Business Mailing Address
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Address Line | 4872 ALTON DR
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City | TROY
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State | MI
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Zip | 48085-5007
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Country | US
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Telephone | 586-873-6589
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAMELIA PETRISOR
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Credential | DDS
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Telephone | 586-873-6589
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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 |
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License Number State |
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