MEDICARE: MILLER CREEK FAMILY DENTAL PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1174478796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER CREEK FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	3337 S AIRPORT RD W STE 1
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7927
Country	:	US
Telephone Number	:	231-252-1033
Fax Number	:	231-252-1066

Provider Business Practice Location Address
First Line	:	3337 S AIRPORT RD W STE 1
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7927
Country	:	US
Telephone Number	:	231-252-1033
Fax Number	:	231-252-1066

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. THOMAS J SHONIKER
Credential	:	DMD
Telephone Number	:	231-492-3721

Provider Enumeration Date	:	02/27/2026
Last Update Date	:	02/27/2026

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