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General NPI Number Information
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NPI Number | 1992014815
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Entity Type | Organization
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Legal Business Name | THE DENTAL GROUP,P.C
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 233 SOUTHBOUND GRATIOT AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2413
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Country | US
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Telephone | 586-465-6503
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Fax |
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Provider Business Mailing Address
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Address Line | 233 SOUTHBOUND GRATIOT AVE
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2413
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Country | US
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Telephone | 586-465-6503
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHAKIB HALABU
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Credential |
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Telephone | 586-465-6503
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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 | 2901011201
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License Number State | MI
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