MEDICARE: PEARL DENTAL P.C.

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	:	1841440245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL DENTAL P.C.

Provider Business Mailing Address
First Line	:	50364 LIVINGSTON DR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-6802
Country	:	US
Telephone Number	:	248-476-4416
Fax Number	:	248-679-8889

Provider Business Practice Location Address
First Line	:	33566 W 8 MILE RD STE B
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-5271
Country	:	US
Telephone Number	:	248-476-4416
Fax Number	:	248-679-8889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHETANA D KARANTH
Credential	:	DDS
Telephone Number	:	248-476-4416

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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