Provider Demographics
NPI:1790006385
Name:ADVANCED WARREN DENTAL PC
Entity Type:Organization
Organization Name:ADVANCED WARREN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIB
Authorized Official - Middle Name:
Authorized Official - Last Name:HALABU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-755-4310
Mailing Address - Street 1:27600 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7721
Mailing Address - Country:US
Mailing Address - Phone:586-755-4310
Mailing Address - Fax:
Practice Address - Street 1:27600 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7721
Practice Address - Country:US
Practice Address - Phone:586-755-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty