MEDICARE: BEYOND ORTHODONTICS, 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1952269946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND ORTHODONTICS, PLLC

Provider Business Mailing Address
First Line	:	33200 W 14 MILE RD STE 100
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3570
Country	:	US
Telephone Number	:	248-702-5232
Fax Number	:	248-702-5214

Provider Business Practice Location Address
First Line	:	33200 W 14 MILE RD STE 100
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3570
Country	:	US
Telephone Number	:	248-702-5232
Fax Number	:	248-702-5214

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	ANGELIQUE THOMAS
Credential	:	DDS
Telephone Number	:	248-320-1701

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/10/2026

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