MEDICARE: CHILDREN'S DENTAL SPECIALISTS OF DETROIT 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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1720942154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S DENTAL SPECIALISTS OF DETROIT PLLC

Provider Business Mailing Address
First Line	:	12707 DEXTER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3341
Country	:	US
Telephone Number	:	248-217-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	12707 DEXTER AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-3341
Country	:	US
Telephone Number	:	248-217-7997
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IFECHIDE NWABUEZE
Credential	:	DMD
Telephone Number	:	248-217-7997

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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