Provider Demographics
NPI:1285475111
Name:SHOHA, PRIA (DDS)
Entity type:Individual
Prefix:
First Name:PRIA
Middle Name:
Last Name:SHOHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W BIG BEAVER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3911
Mailing Address - Country:US
Mailing Address - Phone:248-505-0471
Mailing Address - Fax:
Practice Address - Street 1:50 W BIG BEAVER RD STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3911
Practice Address - Country:US
Practice Address - Phone:248-648-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016022351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice