MEDICARE: DR. STEVEN D SHOHA D.D.S.

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	1223E0200X	Endodontics	16091	MI

General Provider Information

NPI Number	:	1376660621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN D SHOHA D.D.S.

Provider Business Mailing Address
First Line	:	29201 TELEGRAPH RD
Second Line	:	SUITE 110
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-1331
Country	:	US
Telephone Number	:	248-358-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	16151 19 MILE RD
Second Line	:	SUITE 101
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-286-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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