MEDICARE: ALKASS DENTAL GROUP WATERFORD

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619500436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALKASS DENTAL GROUP WATERFORD

Provider Business Mailing Address
First Line	:	1132 VOORHEIS RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-3944
Country	:	US
Telephone Number	:	248-682-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 VOORHEIS RD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-3944
Country	:	US
Telephone Number	:	248-682-6911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER J ALKASS
Credential	:	DDS
Telephone Number	:	586-381-2220

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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