MEDICARE: DR. THOMAS MICHAEL DAVIDSON D.D.S.

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	2901017188	MI

General Provider Information

NPI Number	:	1568553857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MICHAEL DAVIDSON D.D.S.

Provider Business Mailing Address
First Line	:	58047 VAN DYKE RD
Second Line	:	SUITE# 101
City	:	WASHINGTON
State	:	MI
Zip	:	48094-4000
Country	:	US
Telephone Number	:	586-270-6013
Fax Number	:	586-207-6300

Provider Business Practice Location Address
First Line	:	58047 VAN DYKE RD
Second Line	:	SUITE# 101
City	:	WASHINGTON
State	:	MI
Zip	:	48094-4000
Country	:	US
Telephone Number	:	586-270-6013
Fax Number	:	586-207-6300

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/30/2023

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