Provider Demographics
NPI:1871983056
Name:SHORES DENTAL COMPANY
Entity type:Organization
Organization Name:SHORES DENTAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COTY
Authorized Official - Middle Name:SHORES
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-786-2469
Mailing Address - Street 1:1640 W PLATO RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1264
Mailing Address - Country:US
Mailing Address - Phone:580-786-2469
Mailing Address - Fax:580-786-2470
Practice Address - Street 1:1640 W PLATO RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1264
Practice Address - Country:US
Practice Address - Phone:580-786-2469
Practice Address - Fax:580-786-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty