Provider Demographics
NPI:1467619429
Name:OAKLAND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OAKLAND FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIB
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALABU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-855-1855
Mailing Address - Street 1:7125 ORCHARD LAKE RD #310
Mailing Address - Street 2:
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 STE 310
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3620
Practice Address - Country:US
Practice Address - Phone:248-855-1855
Practice Address - Fax:248-855-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM11201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437252467Medicaid
MI1497949945Medicaid