Provider Demographics
NPI:1437980802
Name:SUE SHOHA DDS PLLC
Entity type:Organization
Organization Name:SUE SHOHA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-648-3660
Mailing Address - Street 1:50 W BIG BEAVER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3911
Mailing Address - Country:US
Mailing Address - Phone:248-648-3660
Mailing Address - Fax:
Practice Address - Street 1:50 W BIG BEAVER RD STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3911
Practice Address - Country:US
Practice Address - Phone:248-648-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental