Provider Demographics
NPI:1952357204
Name:SHORES DENTAL CENTER, P.C.
Entity Type:Organization
Organization Name:SHORES DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KALICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-293-1530
Mailing Address - Street 1:31549 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2455
Mailing Address - Country:US
Mailing Address - Phone:586-293-1530
Mailing Address - Fax:586-293-1537
Practice Address - Street 1:31549 HARPER AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2455
Practice Address - Country:US
Practice Address - Phone:586-293-1530
Practice Address - Fax:586-293-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011906122300000X
MI2901015365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty