Healthcare Provider Details

I. General information

NPI: 1972806420
Provider Name (Legal Business Name): AVERIL E. MEARNIC, D.D.S., M.S., PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E GRAND RIVER AVE SUITE 200
BRIGHTON MI
48116-1573
US

IV. Provider business mailing address

225 E GRAND RIVER AVE SUITE 200
BRIGHTON MI
48116-1573
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-9600
  • Fax:
Mailing address:
  • Phone: 810-227-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2901018916
License Number StateMI

VIII. Authorized Official

Name: DR. AVERIL ELIZABETH MEARNIC
Title or Position: OWNER
Credential: D.D.S, M.S
Phone: 810-227-9600