Provider Demographics
NPI:1972553519
Name:SHRINER, PHILIP R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:SHRINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 PEACHTREE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8967
Mailing Address - Country:US
Mailing Address - Phone:517-622-8443
Mailing Address - Fax:517-622-4045
Practice Address - Street 1:6111 PEACHTREE DR
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8967
Practice Address - Country:US
Practice Address - Phone:517-622-8443
Practice Address - Fax:517-622-4045
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3079461Medicaid