Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 10735 | MI |
NPI | 1003946492 |
---|---|
Provider Name | Dr. Douglas Shiffman |
First Address | West Bloomfield, MI 48322-4454 |
Second Address | West Bloomfield, MI 48322-4454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02864 | (02) |