Provider Demographics
NPI:1992014815
Name:THE DENTAL GROUP,P.C
Entity type:Organization
Organization Name:THE DENTAL GROUP,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIB
Authorized Official - Middle Name:
Authorized Official - Last Name:HALABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-465-6503
Mailing Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2413
Mailing Address - Country:US
Mailing Address - Phone:586-465-6503
Mailing Address - Fax:
Practice Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2413
Practice Address - Country:US
Practice Address - Phone:586-465-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty