Provider Demographics
NPI:1033229414
Name:SHORTT, WILLIAM A (DDS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:SHORTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12756 TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178
Mailing Address - Country:US
Mailing Address - Phone:248-437-8189
Mailing Address - Fax:248-437-6819
Practice Address - Street 1:12756 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178
Practice Address - Country:US
Practice Address - Phone:248-437-8189
Practice Address - Fax:248-437-6819
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist