Organization
WIDE SMILES MOBILE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS JOSEPH SHOHA DDS (OWNER)
(586) 649-7906
Entity
Organization
Contact information
Practice address
19332 HUDSON RIVER DR, MACOMB, MI 48044-4241
(586) 649-7906
(586) 231-0118
Mailing address
19332 HUDSON RIVER DR, MACOMB, MI 48044-4241
(586) 649-7906
(586) 231-0118
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
16556
MI
Other
Enumeration date
09/27/2013
Last updated
09/27/2013
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