Active NPI
Talia Marie Shackelford, DDS
- Dentist
- Fort Gratiot, MI
National Provider Identifier
1922415223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901021371
- Practice address
- 4216 24TH Ave
Fort Gratiot, MI 48059-3880 - Phone
- (810) 479-4821
- NPI assigned
- Jul 18, 2014
- Sex
- Female
- 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 | 2901021371 | MI | Primary |
Addresses
Primary practice location
4216 24TH Ave
Fort Gratiot, MI 48059-3880
Mailing address
3350 Crestwater CT Apt 1812
Rochester Hills, MI 48309-2780
Phone (714) 345-3086
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 |
|---|---|---|---|
| 2901021371 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405641600000",
"number": "1922415223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3350 CRESTWATER CT APT 1812",
"city": "ROCHESTER HILLS",
"state": "MI",
"postal_code": "483092780",
"telephone_number": "714-345-3086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4216 24TH AVE",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480593880",
"telephone_number": "810-479-4821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "TALIA",
"middle_name": "MARIE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-18",
"last_updated": "2014-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901021371",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gratiot, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.