MEDICARE: DR. LOUIS A SHAHEEN D.D.S., PLC

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	122300000X	Dentist	014184	MI

General Provider Information

NPI Number	:	1437585627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS A SHAHEEN D.D.S., PLC

Provider Business Mailing Address
First Line	:	G9171 NORTH SAGINAW ST.
Second Line	:	P.O. BOX 247
City	:	MT. MORRIS
State	:	MI
Zip	:	48458
Country	:	US
Telephone Number	:	810-687-3010
Fax Number	:	810-687-1228

Provider Business Practice Location Address
First Line	:	G9171 NORTH SAGINAW ST.
Second Line	:
City	:	MT. MORRIS
State	:	MI
Zip	:	48458
Country	:	US
Telephone Number	:	810-687-3010
Fax Number	:	810-687-1228

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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