Provider Demographics
NPI:1013086396
Name:SHAH, HINA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HINA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3955 OKEMOS RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4208
Mailing Address - Country:US
Mailing Address - Phone:517-381-9941
Mailing Address - Fax:517-381-9958
Practice Address - Street 1:3955 OKEMOS RD
Practice Address - Street 2:SUITE B3
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4208
Practice Address - Country:US
Practice Address - Phone:517-381-9941
Practice Address - Fax:517-381-9958
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010149041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4230813Medicaid