Provider Demographics
NPI:1619006509
Name:SHOUKFEH, SAMER M
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:M
Last Name:SHOUKFEH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SAMER
Other - Middle Name:
Other - Last Name:SHOUKFEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5958 N CANTON CENTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2766
Mailing Address - Country:US
Mailing Address - Phone:734-459-4960
Mailing Address - Fax:
Practice Address - Street 1:5958 N CANTON CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2766
Practice Address - Country:US
Practice Address - Phone:734-459-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184701223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901018470OtherSTATE LICENSE
MI4689868-12Medicaid
MI4805018-12Medicaid