Provider Demographics
NPI:1740484963
Name:SHOHA, SUCHETA GODE (DDS)
Entity type:Individual
Prefix:DR
First Name:SUCHETA
Middle Name:GODE
Last Name:SHOHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:SHOHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:50 W BIG BEAVER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3911
Mailing Address - Country:US
Mailing Address - Phone:248-648-3660
Mailing Address - Fax:248-792-6631
Practice Address - Street 1:50 W BIG BEAVER RD STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3911
Practice Address - Country:US
Practice Address - Phone:248-648-3660
Practice Address - Fax:248-792-6631
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0151621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice