Provider Demographics
NPI:1225419468
Name:SHAHEEN, YASER (DMD)
Entity Type:Individual
Prefix:
First Name:YASER
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27115 NORTHMORE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3643
Mailing Address - Country:US
Mailing Address - Phone:313-918-5188
Mailing Address - Fax:
Practice Address - Street 1:3211 COOLIDGE HIGH WAY
Practice Address - Street 2:#204
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2926
Practice Address - Country:US
Practice Address - Phone:313-389-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice