Provider Demographics
NPI:1881173763
Name:SHELBY FAMILY COSMETIC & RESTORATIVE DENTISTRY
Entity type:Organization
Organization Name:SHELBY FAMILY COSMETIC & RESTORATIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARNALDO
Authorized Official - Middle Name:ISADORE
Authorized Official - Last Name:DIREZZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-726-0030
Mailing Address - Street 1:51221 SCHOENHERR ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-726-0030
Mailing Address - Fax:586-726-0090
Practice Address - Street 1:51221 SCHOENHERR ROAD.
Practice Address - Street 2:SUITE 102
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-726-0030
Practice Address - Fax:586-726-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI108264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty