Shane T. Citron, D.D.S., M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

2901017389 Issued in MI

Practice address

5090 E Hill Rd
Grand Blanc, MI 48439-7637

Phone

(810) 445-9970

Fax

(810) 445-9971

NPI assigned

Aug 9, 2010

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2023 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1588979009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5090 E HILL RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397637",
            "telephone_number": "810-445-9970",
            "fax_number": "810-445-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5090 E HILL RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397637",
            "telephone_number": "810-445-9970",
            "fax_number": "810-445-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CITRON",
        "first_name": "SHANE",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-09",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NH",
            "license": "03796",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "2901017389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher F Herzog, D.O., PC
• Jordan Christopher, DO
• Yong S Chung, M.D.
• Linda Chute, P.A.
• Joelle Ann Cirella-Grandy, OTR/L
• Michelle Marie Clark, LMSW
• Toni Clark, M.ED, BCBA, LBA
• Kenyetta Clarke
• Valeria Dionne Clarke
• Camara D Clements

• Oral & Maxillofacial Surgery (D.M.D.) in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.