Basam Shamo, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901020972 Issued in MI

Practice address

22972 Lahser Rd Ste 2
Southfield, MI 48033-4408

Phone

(248) 864-2500

NPI assigned

Jun 10, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1376981530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22972 LAHSER RD STE 2",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480334408",
            "telephone_number": "248-864-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22972 LAHSER RD STE 2",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480334408",
            "telephone_number": "248-864-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMO",
        "first_name": "BASAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-10",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020972",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901020972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shalom Home Care, Inc
• Shalom Therapy Services LLC
• Jeane Shamblin
• Lama Shami, BCBA, LBA
• Lydia Shami
• Shawynque Whitney Shankin, LMFT
• Bethany R Shanku, PA-C
• Shannon S Wysinger, LLC
• Shira Shapero, BCBA
• Jeffrey D Shapiro, MD

• Pediatric Dentistry in Southfield, MI
• Providers in Southfield, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.