Provider Demographics
NPI:1477911832
Name:SHANNA MCGETTRICK DDS,PC
Entity type:Organization
Organization Name:SHANNA MCGETTRICK DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGETTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-354-1555
Mailing Address - Street 1:19178 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2445
Mailing Address - Country:US
Mailing Address - Phone:248-354-1555
Mailing Address - Fax:248-354-3331
Practice Address - Street 1:6804 MEADOW CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2032
Practice Address - Country:US
Practice Address - Phone:248-354-1555
Practice Address - Fax:248-354-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020026261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922234988Medicaid