Provider Demographics
NPI:1851003925
Name:SHADI KRECHT DMD PLLC
Entity Type:Organization
Organization Name:SHADI KRECHT DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-504-3933
Mailing Address - Street 1:190 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1447
Mailing Address - Country:US
Mailing Address - Phone:561-504-3933
Mailing Address - Fax:
Practice Address - Street 1:9389 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-928-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty