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Organization

SHADOWS O.BEDELL DDS.P.C.

Active
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Organization

SHADOWS O.BEDELL DDS.P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SHADOWS O BEDELL D.D.S.P.C. (DENTIST)
(313) 892-9148
Entity
Organization

Contact information

Practice address
19600 VAN DYKE ST, DETROIT, MI 48234-3325
(313) 892-9148
(313) 892-0204
Mailing address
19600 VAN DYKE ST, DETROIT, MI 48234-3325
(313) 892-9148
(313) 892-0204

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12360
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083663702
—
MI
05
—
1720148018
—
MI
05
—
1801967757
—
MI
Enumeration date
10/23/2007
Last updated
11/02/2007
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