MEDICARE: WEST OAKS DENTAL GROUP

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	11122	MI

General Provider Information

NPI Number	:	1538205125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OAKS DENTAL GROUP

Provider Business Mailing Address
First Line	:	33200 W 14 MILE RD
Second Line	:	SUITE 100
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3563
Country	:	US
Telephone Number	:	248-406-0180
Fax Number	:	248-406-5088

Provider Business Practice Location Address
First Line	:	33200 W 14 MILE RD
Second Line	:	SUITE 100
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3563
Country	:	US
Telephone Number	:	248-406-0180
Fax Number	:	248-406-5088

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGE NATHAN SELIGMAN
Credential	:	DDS
Telephone Number	:	248-406-0180

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	09/30/2009

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