Healthcare Provider Details

I. General information

NPI: 1518058841
Provider Name (Legal Business Name): WARREN ROBERT TESSLER DDS M.SC.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24924 MICHIGAN AVE
DEARBORN MI
48124-1740
US

IV. Provider business mailing address

24924 MICHIGAN AVE
DEARBORN MI
48124-1740
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-8522
  • Fax: 313-274-5396
Mailing address:
  • Phone: 313-274-8522
  • Fax: 313-274-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number008519
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: