MEDICARE: H2G DENTAL PLLC

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

General Provider Information

NPI Number	:	1629739750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H2G DENTAL PLLC

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:
City	:	RICHMOND
State	:	MI
Zip	:	48062-0460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 ALLEN RD STE 105
Second Line	:
City	:	ALLEN PARK
State	:	MI
Zip	:	48101-1157
Country	:	US
Telephone Number	:	313-383-3000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MICHAEL SCHAAF
Credential	:
Telephone Number	:	269-217-6442

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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