Provider Demographics
NPI:1114404738
Name:SHELBY COMFORT DENTISTRY
Entity Type:Organization
Organization Name:SHELBY COMFORT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER / ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:DORETTE HOPE
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-248-4500
Mailing Address - Street 1:56625 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316
Mailing Address - Country:US
Mailing Address - Phone:586-248-4500
Mailing Address - Fax:586-371-0342
Practice Address - Street 1:56625 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5025
Practice Address - Country:US
Practice Address - Phone:586-286-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY COMFORT DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-26
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental