Shadows O.Bedell DDS.P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12360 Issued in MI

Legal business name

SHADOWS O.BEDELL DDS.P.C.

Practice address

19600 Van Dyke St
Detroit, MI 48234-3325

Phone

(313) 892-9148

Fax

(313) 892-0204

NPI assigned

Oct 23, 2007

Last updated

Nov 2, 2007By 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. Shadows O Bedell, D.D.S.P.C.NPI 1083663702

Title

Dentist

Phone

(313) 892-9148

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shadows Oye Bedell, D.D.S.

  • General Practice Dentistry
  • Detroit, MI
  • NPI 1083663702
  NPD (past) Authorized official

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1427247758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19600 VAN DYKE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343325",
            "telephone_number": "313-892-9148",
            "fax_number": "313-892-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19600 VAN DYKE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482343325",
            "telephone_number": "313-892-9148",
            "fax_number": "313-892-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOWS O.BEDELL DDS.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "SHADOWS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "313-892-9148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.P.C."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720148018",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801967757",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083663702",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noreen F Shackelford, RN
• Shiyan Adore Shackleford
• Sheldon Shadaia
• Thomas Shadaya
• Al Muthanna Amjad Shadid, MD
• Julisa Shadwick
• Annabelle Shaffer, MD, MS
• Zeinab Shafie-Khorassani
• Rima M Shafie, RPH
• Saad R. Shafie, R.PH

• General Practice Dentistry in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; 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.