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NPI Code Detail

MEDICARE: EIGHT MILE DENTAL SPECIALISTS PC

MEDICARE: EIGHT MILE DENTAL SPECIALISTS PC
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1376843136
Entity Type Code : Organization
Provider Name (Legal Business Name) : EIGHT MILE DENTAL SPECIALISTS PC
Provider Business Mailing Address
First Line : PO BOX 38367
Second Line :
City : DETROIT
State : MI
Zip : 48238-0367
Country : US
Telephone Number : 313-454-4800
Fax Number : 313-341-7867
Provider Business Practice Location Address
First Line : 511 W 8 MILE RD
Second Line :
City : DETROIT
State : MI
Zip : 48203-1004
Country : US
Telephone Number : 313-454-4800
Fax Number : 313-341-7867
Authorized Official
Title or Position : OFFICE MGR
Name : LEONA M RUGENSKI
Credential :
Telephone Number : 313-454-4800
Provider Enumeration Date : 10/27/2010
Last Update Date : 10/27/2010

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Directions to “EIGHT MILE DENTAL SPECIALISTS PC ” Practice Location

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