Healthcare Provider Details

I. General information

NPI: 1811124654
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 04/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 UNION LAKE RD STE 218
COMMERCE MI
48382
US

IV. Provider business mailing address

2900 UNION LAKE RD STE 218
COMMERCE MI
48382
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-9345
  • Fax: 248-363-9346
Mailing address:
  • Phone: 248-363-9345
  • Fax: 248-363-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10551
License Number StateMH

VIII. Authorized Official

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