Healthcare Provider Details

I. General information

NPI: 1457215204
Provider Name (Legal Business Name): K-12 MOBILE DENTAL EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 PINEHURST DR
CANTON MI
48188-3078
US

IV. Provider business mailing address

519 PINEHURST DR
CANTON MI
48188-3078
US

V. Phone/Fax

Practice location:
  • Phone: 734-351-3200
  • Fax:
Mailing address:
  • Phone: 734-351-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STERLING CHEEKS
Title or Position: CEO
Credential:
Phone: 734-351-3200