Provider Demographics
NPI:1609823327
Name:LOUIS A SHAHEEN DDS PLC
Entity Type:Organization
Organization Name:LOUIS A SHAHEEN DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-687-3010
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458
Mailing Address - Country:US
Mailing Address - Phone:810-687-3010
Mailing Address - Fax:810-687-1228
Practice Address - Street 1:G 9115 NORTH SAGINAW
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458
Practice Address - Country:US
Practice Address - Phone:810-687-3010
Practice Address - Fax:810-687-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14184261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental