MEDICARE: D2 DENTAL OF MICHIGAN

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	:	1821420043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D2 DENTAL OF MICHIGAN

Provider Business Mailing Address
First Line	:	137 N OAK PARK AVE
Second Line	:	SUITE 302A
City	:	OAK PARK
State	:	IL
Zip	:	60301-1344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 JACKSON XING
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2039
Country	:	US
Telephone Number	:	517-841-0000
Fax Number	:

Authorized Official
Title or Position	:	AGENT
Name	:	MR. BORIS LABINOV
Credential	:
Telephone Number	:	708-386-4800

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	11/15/2013

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Directions to “D2 DENTAL OF MICHIGAN ” Practice Location

Language	Start Address	Practice Location

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