Provider Demographics
NPI:1184922122
Name:ARTISTIC DENTISTRY
Entity type:Organization
Organization Name:ARTISTIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAABAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-914-2595
Mailing Address - Street 1:5005 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3252
Mailing Address - Country:US
Mailing Address - Phone:313-914-2595
Mailing Address - Fax:
Practice Address - Street 1:5005 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3252
Practice Address - Country:US
Practice Address - Phone:313-384-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018367261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental