| Shane Davidson Dds Pc | |
|
5574 Cooley Lake Rd Waterford MI 48327-3015 | |
| (248) 977-3006 | |
| Not Available |
| Full Name | Shane Davidson Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 5574 Cooley Lake Rd, Waterford, Michigan |
| Authorized Official Name and Position | Shane Davidson (OWNER) |
| Authorized Official Contact | 2489773006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shane Davidson Dds Pc 5574 Cooley Lake Rd Waterford MI 48327-3015 Ph: (248) 977-3006 | Shane Davidson Dds Pc 5574 Cooley Lake Rd Waterford MI 48327-3015 Ph: (248) 977-3006 |
| NPI Number | 1033651427 |
|---|---|
| Provider Enumeration Date | 11/16/2016 |
| Last Update Date | 11/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033651427 | NPI | - | NPPES |
| 2901020222 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901020222 (Michigan) | Primary |
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