Healthcare Provider Details

I. General information

NPI: 1104292713
Provider Name (Legal Business Name): NICOLE D TEIFER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44633 JOY RD STE 300
CANTON MI
48187-1730
US

IV. Provider business mailing address

44633 JOY RD STE 300
CANTON MI
48187-1730
US

V. Phone/Fax

Practice location:
  • Phone: 734-454-9200
  • Fax:
Mailing address:
  • Phone: 734-454-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NICOLE TEIFER
Title or Position: OWNER
Credential: DDS MSD
Phone: 734-454-9200