Provider Demographics
NPI:1437390556
Name:BEDIKIAN, SHANT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANT
Middle Name:C
Last Name:BEDIKIAN
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 1:1070 W HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8701
Mailing Address - Country:US
Mailing Address - Phone:517-234-7774
Mailing Address - Fax:
Practice Address - Street 1:1070 W HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8701
Practice Address - Country:US
Practice Address - Phone:517-234-7774
Practice Address - Fax:517-234-7473
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice