Shane Terry Davidson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901020222 Issued in MI

Practice address

7805 Cooley Lake Rd Ste 400
West Bloomfield, MI 48324-3535

Phone

(248) 977-3006

Fax

(248) 242-6762

NPI assigned

Jun 22, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shane Davidson DDS PC

  • Dentist
  • Waterford, MI
  • NPI 1033651427
  NPD (past) Authorized official

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1710208053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 HERSHEY BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483272435",
            "telephone_number": "248-860-2031",
            "fax_number": "248-499-6424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7805 COOLEY LAKE RD STE 400",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483243535",
            "telephone_number": "248-977-3006",
            "fax_number": "248-242-6762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "SHANE",
        "middle_name": "TERRY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-22",
        "last_updated": "2023-08-08",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "contactus@shanedavidsondds.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7805 Cooley Lake Rd Ste 400",
            "city": "West Bloomfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483243535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrea Dasky
• Champa Dassanayake, MD
• Emilie Dauch, LLP
• David a Leichtman, M.D., PC
• David D Budaj PC
• Ashley Ann Davies, OTR/L
• Cyril Davis
• Jason James Davis, M.D.
• Raeleen Nicole Davis, MA, LPC
• Ron Davis, LLP

• General Practice Dentistry in West Bloomfield, MI
• Providers in West Bloomfield, 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 Aug 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.