Healthcare Provider Details

I. General information

NPI: 1306910930
Provider Name (Legal Business Name): MGM DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39400 GARFIELD SUITE 100
CLINTON TWP MI
48038
US

IV. Provider business mailing address

39400 GARFIELD SUITE 100
CLINTON TWP MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-4720
  • Fax: 586-263-0237
Mailing address:
  • Phone: 586-263-4720
  • Fax: 586-263-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14409
License Number StateMI

VIII. Authorized Official

Name: DR. GREGORY J FRANKLIN
Title or Position: OWNER
Credential: DDS
Phone: 586-263-4720