| Organization Name: | SHELBY DENTAL CENTER P.C. |
| NPI Number: | 1154626687 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WAFID W KIZY (DENTIST) |
| Mailing Address: | 47059 Van Dyke Ave Shelby Twp |
| State: | MI US |
| Postal Code: | 483173357 |
| Phone Number: | 5867372778 |
| Fax Number: | 5867372776 |
| NPI Enumeration Date: | 01/13/2011 |
| NPI Last Update Date: | 01/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 1823026 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |