Provider Demographics
NPI:1760749592
Name:SHEHATA, NERMINE NADER (DMD)
Entity Type:Individual
Prefix:
First Name:NERMINE
Middle Name:NADER
Last Name:SHEHATA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NERMINE
Other - Middle Name:NADER
Other - Last Name:BASSILY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:573 W VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-5000
Mailing Address - Country:US
Mailing Address - Phone:810-686-5220
Mailing Address - Fax:810-686-1620
Practice Address - Street 1:573 W VIENNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-5000
Practice Address - Country:US
Practice Address - Phone:810-686-5220
Practice Address - Fax:810-686-1620
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice