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NPI Code Detail

MEDICARE: MR. OBADIAH JAY PIRLO DDS

MEDICARE: MR. OBADIAH JAY PIRLO DDS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentist2901603128MI

General Provider Information

NPI Number : 1679271761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OBADIAH JAY PIRLO DDS
Provider Business Mailing Address
First Line : 2215 FULLER RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-2303
Country : US
Telephone Number : 734-769-7100
Fax Number :
Provider Business Practice Location Address
First Line : 2215 FULLER RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48105-2303
Country : US
Telephone Number : 734-769-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2023
Last Update Date : 06/12/2026

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