Fred Shorter, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901010185 Issued in MI

Practice address

20100 W McNichols Rd
Detroit, MI 48219-3374

Phone

(313) 255-2150

Fax

(313) 255-6152

NPI assigned

Jun 20, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Fred Shorter Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669477154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20100 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193374",
            "telephone_number": "313-255-2150",
            "fax_number": "313-255-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20100 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482193374",
            "telephone_number": "313-255-2150",
            "fax_number": "313-255-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORTER",
        "first_name": "FRED",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901010185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4199929",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FRED",
            "last_name": "SHORTER",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Naja Yahya Shohatee
• Aasha Saraswati Shonek
• Samuel Shopinski
• Shores Internal Medicine P.C.
• Caleb Christian Short, DO
• Lynnette Shorter
• Nicole Shorter
• Douglas Shortridge, DO
• Rajaa Shoukfeh, MD
• Marie Shoulders-Williams, FNP

• 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 Jul 8, 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.