Provider Demographics
NPI:1437252467
Name:HALABU, SHAKIB ELIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAKIB
Middle Name:ELIAS
Last Name:HALABU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 ORCHARD LAKE RD
Mailing Address - Street 2:STE 310
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-855-1855
Mailing Address - Fax:248-855-3824
Practice Address - Street 1:7125 ORCHARD LAKE RD
Practice Address - Street 2:STE 310
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-855-1855
Practice Address - Fax:248-855-3824
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4537220Medicaid