MEDICARE: DR. BRADY ROBBINS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	2901601039	MI

General Provider Information

NPI Number	:	1033786421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADY ROBBINS DDS

Provider Business Mailing Address
First Line	:	17894 VIOLET DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-6200
Country	:	US
Telephone Number	:	701-520-2874
Fax Number	:

Provider Business Practice Location Address
First Line	:	559 W. GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-2200
Country	:	US
Telephone Number	:	313-499-4775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2021
Last Update Date	:	08/23/2021

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Directions to “ DR. BRADY ROBBINS DDS” Practice Location

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