Organization
PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
Active
Other names
Dental Care of Michigan, Roseville
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKIB HALABU (DENTIST)
(248) 397-1165
Entity
Organization
Contact information
Practice address
25631 GRATIOT AVE, ROSEVILLE, MI 48066-4434
(586) 775-3312
(586) 775-4780
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3613
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901011201
MI
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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