MEDICARE: NEW YOU DENTAL MGMT- AUBURN HILLS

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	:	1932522976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YOU DENTAL MGMT- AUBURN HILLS

Provider Business Mailing Address
First Line	:	23225 NORTHWESTERN HWY
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-7707
Country	:	US
Telephone Number	:	248-595-0161
Fax Number	:	248-416-1048

Provider Business Practice Location Address
First Line	:	4139 BALDWIN RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1225
Country	:	US
Telephone Number	:	248-595-0161
Fax Number	:	248-416-1048

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	JANE PAISOPOULOS
Credential	:
Telephone Number	:	248-595-0161

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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