MEDICARE: DR. JENNIFER MARIE SHAHEEN-MCNIEL DDS

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	1223G0001X	General Practice Dentistry	2901019994	MI

General Provider Information

NPI Number	:	1972801314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MARIE SHAHEEN-MCNIEL DDS

Provider Business Mailing Address
First Line	:	1905 ABBOTT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8571
Country	:	US
Telephone Number	:	517-351-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 ABBOTT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8571
Country	:	US
Telephone Number	:	517-351-6140
Fax Number	:

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

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	04/02/2015

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