Wide Smiles Mobile Dental

Primary specialty

DentistTaxonomy code 122300000X

License

16556 Issued in MI

Legal business name

WIDE SMILES MOBILE DENTAL

Practice address

19332 Hudson River Dr
Macomb, MI 48044-4241

Phone

(586) 649-7906

Fax

(586) 231-0118

NPI assigned

Sep 27, 2013

Last updated

Sep 27, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Douglas Joseph Shoha, DDS

Title

Owner

Phone

(586) 649-7906

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1255768818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19332 HUDSON RIVER DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480444241",
            "telephone_number": "586-649-7906",
            "fax_number": "586-231-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19332 HUDSON RIVER DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480444241",
            "telephone_number": "586-649-7906",
            "fax_number": "586-231-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIDE SMILES MOBILE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "SHOHA",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-649-7906",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "16556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weiss Chiropractic Macomb
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• Samantha White, AU.D.
• Stephen Matthew White, AGPCBC-NP
• Kelsie Wilbon, PT, DPT
• Samantha Wiles, BCBA
• Gwendolyn Wilhelm
• William Beauont Hospital (Corewell Health Beaumont Troy Hospital)
• Theresa Marie Williams, DC

• Dentist in Macomb, MI
• Providers in Macomb, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.