MEDICARE: K-12 MOBILE DENTAL EXPRESS LLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1457215204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K-12 MOBILE DENTAL EXPRESS LLC

Provider Business Mailing Address
First Line	:	519 PINEHURST DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-3078
Country	:	US
Telephone Number	:	734-351-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 PINEHURST DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-3078
Country	:	US
Telephone Number	:	734-351-3200
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STERLING CHEEKS
Credential	:
Telephone Number	:	734-351-3200

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “K-12 MOBILE DENTAL EXPRESS LLC ” Practice Location

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