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NPI Code Detail

MEDICARE: SHELBY NICOLE TACEY RDH

MEDICARE: SHELBY NICOLE TACEY RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist2902019648MI

General Provider Information

NPI Number : 1073213658
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY NICOLE TACEY RDH
Provider Business Mailing Address
First Line : 175 CASS AVENUE RD
Second Line :
City : MUNGER
State : MI
Zip : 48747-9719
Country : US
Telephone Number : 469-847-1866
Fax Number :
Provider Business Practice Location Address
First Line : 2614 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6300
Country : US
Telephone Number : 989-402-0510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2023
Last Update Date : 03/03/2023

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Directions to “ SHELBY NICOLE TACEY RDH” Practice Location

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