Healthcare Provider Details

I. General information

NPI: 1891742607
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15870 19 MILE ROAD STE 110
CLINTON TWP MI
48038
US

IV. Provider business mailing address

15870 19 MILE ROAD STE 110
CLINTON TWP MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-3390
  • Fax:
Mailing address:
  • Phone: 586-286-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD C DIETZ JR.
Title or Position: PARTNER DOCTOR
Credential: DDS
Phone: 248-647-7930