Active NPI
Blake Michael Shaffou, DDS
- Dentist
- Warren, MI
National Provider Identifier
1629969597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901602609
- Practice address
- 13403 E 13 Mile Rd
Warren, MI 48088-3188 - Phone
- (586) 979-2800
- NPI assigned
- Jul 10, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901602609 | MI | Primary |
Addresses
Primary practice location
13403 E 13 Mile Rd
Warren, MI 48088-3188
Mailing address
1091 Forest Bay CT
Waterford, MI 48328-4283
Phone (248) 672-9202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901602609 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752105600000",
"number": "1629969597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1091 FOREST BAY CT",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483284283",
"telephone_number": "248-672-9202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13403 E 13 MILE RD",
"city": "WARREN",
"state": "MI",
"postal_code": "480883188",
"telephone_number": "586-979-2800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFOU",
"first_name": "BLAKE",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-10",
"last_updated": "2025-07-10",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901602609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.