Provider Demographics
NPI:1003505587
Name:SHAHU DENTISTRY, PLLC DBA EXCEL DENTAL DEPOT
Entity Type:Organization
Organization Name:SHAHU DENTISTRY, PLLC DBA EXCEL DENTAL DEPOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:989-387-9767
Mailing Address - Street 1:6415 MOONSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7811
Mailing Address - Country:US
Mailing Address - Phone:989-387-9767
Mailing Address - Fax:
Practice Address - Street 1:3368 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3008
Practice Address - Country:US
Practice Address - Phone:989-387-9767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental