Provider Demographics
NPI:1437699550
Name:PHILIP R SHRINER DDS PC
Entity Type:Organization
Organization Name:PHILIP R SHRINER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SHRINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-622-8443
Mailing Address - Street 1:6111 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8967
Mailing Address - Country:US
Mailing Address - Phone:517-622-8443
Mailing Address - Fax:517-622-4045
Practice Address - Street 1:6111 PEACHTREE DR
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8967
Practice Address - Country:US
Practice Address - Phone:517-622-8443
Practice Address - Fax:517-622-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2915885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty