Provider Demographics
NPI:1740988252
Name:REUBEN, SHALOM (DDS)
Entity type:Individual
Prefix:
First Name:SHALOM
Middle Name:
Last Name:REUBEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 RED WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1769
Mailing Address - Country:US
Mailing Address - Phone:330-515-0479
Mailing Address - Fax:
Practice Address - Street 1:900 E CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5624
Practice Address - Country:US
Practice Address - Phone:517-394-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016023941223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice