Provider Demographics
NPI:1649788688
Name:SAMER G. SHAMOON, DDS, PC
Entity type:Organization
Organization Name:SAMER G. SHAMOON, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TODAY'S SMILE
Authorized Official - Middle Name:CENTER
Authorized Official - Last Name:P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-543-1778
Mailing Address - Street 1:600 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3027
Mailing Address - Country:US
Mailing Address - Phone:248-543-1778
Mailing Address - Fax:
Practice Address - Street 1:600 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3027
Practice Address - Country:US
Practice Address - Phone:248-543-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14187261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental