# PREFERRED DENTAL PRACTICE, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nicholas Thomas DDS & Robert Shore DDS, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841383841
- **Authorized official:** DR. TIMOTHY GERRIT DEMEULENAERE DDS (GENERAL DENTIST/PRESIDENT)
- **Authorized official phone:** (586) 772-2090

## Contact information

- **Practice address:** 24901 KELLY RD, EASTPOINTE, MI 48021-1367
- **Practice address phone:** (586) 772-2090
- **Practice address fax:** (586) 772-0742
- **Mailing address:** 24901 KELLY RD, EASTPOINTE, MI 48021-1367
- **Mailing address phone:** (586) 772-2090
- **Mailing address fax:** (586) 772-0742

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 07/31/2024