Healthcare Provider Details

I. General information

NPI: 1245649789
Provider Name (Legal Business Name): CARE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5237 OAKMAN BLVD
DEARBORN MI
48126-4045
US

IV. Provider business mailing address

5237 OAKMAN BLVD
DEARBORN MI
48126-4045
US

V. Phone/Fax

Practice location:
  • Phone: 313-945-9977
  • Fax: 313-945-9970
Mailing address:
  • Phone: 313-945-9977
  • Fax: 313-945-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. RANDA DAGHER
Title or Position: OWNER/MANAGER
Credential:
Phone: 313-945-9977