Provider Demographics
NPI:1952915944
Name:SHAKEEL A NIAZI DDS PC
Entity type:Organization
Organization Name:SHAKEEL A NIAZI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKEEL
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-596-9620
Mailing Address - Street 1:1390 W AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4812
Mailing Address - Country:US
Mailing Address - Phone:586-596-9620
Mailing Address - Fax:248-299-9235
Practice Address - Street 1:1390 W AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4812
Practice Address - Country:US
Practice Address - Phone:586-596-9620
Practice Address - Fax:248-299-9235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518184043Medicaid