Provider Demographics
NPI:1184827594
Name:TANDEL, SHAMMI V (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAMMI
Middle Name:V
Last Name:TANDEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 CHAMPLAIN CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3529
Mailing Address - Country:US
Mailing Address - Phone:734-620-2587
Mailing Address - Fax:
Practice Address - Street 1:26711 WOODWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1367
Practice Address - Country:US
Practice Address - Phone:248-583-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054657-1122300000X
MI29010194761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist