Healthcare Provider Details

I. General information

NPI: 1841316759
Provider Name (Legal Business Name): ORTHODONTIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S OLD WOODWARD AVE SUITE 605
BIRMINGHAM MI
48009-6658
US

IV. Provider business mailing address

555 S OLD WOODWARD AVE SUITE 605
BIRMINGHAM MI
48009-6658
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-5400
  • Fax: 248-644-4954
Mailing address:
  • Phone: 248-644-5400
  • Fax: 248-644-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS R GEBECK JR.
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 248-644-5400