MEDICARE: ORCHARD LAKE DENTAL CARE

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

General Provider Information

NPI Number	:	1578264040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORCHARD LAKE DENTAL CARE

Provider Business Mailing Address
First Line	:	2711 ORCHARD LAKE RD
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-1446
Country	:	US
Telephone Number	:	248-910-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 ORCHARD LAKE RD
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-1446
Country	:	US
Telephone Number	:	248-682-0922
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY YALDO
Credential	:	DDS
Telephone Number	:	248-910-5709

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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Directions to “ORCHARD LAKE DENTAL CARE ” Practice Location

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