Shorter, Fred

Shorter, Fred is an individual health care provider with primary practice located at 20100 W Mcnichols Rd , Detroit MI 48219-3374. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Shorter, Fred can be contacted via phone (313) 255-2150.

Contact Information

Primary practice address
20100 W Mcnichols Rd Detroit MI 48219-3374
Fax: (313) 255-6152
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2901010185 Michigan

Profile Details

NPI number 1669477154
LBN Legal business name Shorter, Fred
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2005
Last updated Jul 8th, 2007 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669477154 NPPES
Michigan MEDICAID 4199929

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