Healthcare Provider Details

I. General information

NPI: 1679741904
Provider Name (Legal Business Name): ROOT CANAL SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31100 TELEGRAPH RD SUITE 120
BINGHAM FARMS MI
48025-4363
US

IV. Provider business mailing address

31100 TELEGRAPH RD SUITE 120
BINGHAM FARMS MI
48025-4363
US

V. Phone/Fax

Practice location:
  • Phone: 248-540-9191
  • Fax: 248-540-9194
Mailing address:
  • Phone: 248-540-9191
  • Fax: 248-540-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901017183
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901016606
License Number StateMI

VIII. Authorized Official

Name: DR. STEPHEN THOMAS MCINERNEY
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 248-540-9191