Healthcare Provider Details

I. General information

NPI: 1164537890
Provider Name (Legal Business Name): NORTH OAKLAND ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 DIXIE HIGHWAY SUITE 3
CLARKSTON MI
48346-5101
US

IV. Provider business mailing address

6803 DIXIE HIGHWAY SUITE 3
CLARKSTON MI
48346-5101
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-8070
  • Fax: 248-625-8087
Mailing address:
  • Phone: 248-625-8070
  • Fax: 248-625-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901017939
License Number StateMI

VIII. Authorized Official

Name: DR. ANGLA SUZANNE DEKOCK
Title or Position: OWNER/PRESIDNET
Credential: DDS
Phone: 248-625-8070