Provider Demographics
NPI:1710613062
Name:JACK SHADER & MARK DENNIS DDS PC
Entity Type:Organization
Organization Name:JACK SHADER & MARK DENNIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-328-8888
Mailing Address - Street 1:16104 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-1004
Mailing Address - Country:US
Mailing Address - Phone:248-328-8888
Mailing Address - Fax:248-634-0440
Practice Address - Street 1:16104 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-1004
Practice Address - Country:US
Practice Address - Phone:248-328-8888
Practice Address - Fax:248-634-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental