Provider Demographics
NPI:1083947162
Name:POINTE FAMILY DENTISTRY-SHELBY PLLC
Entity Type:Organization
Organization Name:POINTE FAMILY DENTISTRY-SHELBY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:VAN WALLEGHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:586-803-8300
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-803-8300
Mailing Address - Fax:586-803-8305
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-803-8300
Practice Address - Fax:586-803-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6520740001Medicare NSC