Healthcare Provider Details

I. General information

NPI: 1497687818
Provider Name (Legal Business Name): PAUL VERSIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 S TELEGRAPH RD
DEARBORN MI
48124-3286
US

IV. Provider business mailing address

40 STONETREE CIR
ROCHESTER HILLS MI
48309-1136
US

V. Phone/Fax

Practice location:
  • Phone: 313-563-1860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603084
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: