MEDICARE: TREVOR KAY 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	122300000X	Dentist	2901021870	MI

General Provider Information

NPI Number	:	1477902567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR KAY DDS

Provider Business Mailing Address
First Line	:	2017 N WILSON AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4269
Country	:	US
Telephone Number	:	586-817-0367
Fax Number	:

Provider Business Practice Location Address
First Line	:	6668 BERNIE KOHLER DR
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8885
Country	:	US
Telephone Number	:	810-688-3047
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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