Organization
SHANE DAVIDSON DDS PC
Active
Parent organization
SHANE DAVIDSON DDS PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHANE DAVIDSON DDS PC
Authorized official
SHANE DAVIDSON DDS (OWNER)
(248) 977-3006
Entity
Organization
Contact information
Practice address
5574 COOLEY LAKE RD, WATERFORD, MI 48327-3015
(248) 977-3006
Mailing address
5574 COOLEY LAKE RD, WATERFORD, MI 48327-3015
(248) 977-3006
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020222
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2901020222
—
MI
Enumeration date
11/16/2016
Last updated
11/16/2016
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