Provider Demographics
NPI:1235535089
Name:ALZAHRANI, SHADI (BDS)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:ALZAHRANI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 HOSPITAL DRIVE
Mailing Address - Street 2:G1218 TOWSLEY
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:FLOOR 1, RECEPTION A, ROOM 1904
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0312
Practice Address - Country:US
Practice Address - Phone:734-615-6095
Practice Address - Fax:734-764-3485
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP13721223S0112X
MI2951000644390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery