Healthcare Provider Details

I. General information

NPI: 1598898744
Provider Name (Legal Business Name): LAURIE K MCCAULEY DMD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1562
  • Fax: 734-763-3389
Mailing address:
  • Phone: 734-764-1562
  • Fax: 734-763-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016012
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901016012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: