Healthcare Provider Details

I. General information

NPI: 1376281931
Provider Name (Legal Business Name): DRUSKOVICH DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45140 M 51
DECATUR MI
49045-9094
US

IV. Provider business mailing address

45140 M 51
DECATUR MI
49045-9094
US

V. Phone/Fax

Practice location:
  • Phone: 269-423-7866
  • Fax: 269-423-7866
Mailing address:
  • Phone: 269-423-7866
  • Fax: 269-423-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL CHARLES DRUSKOVICH
Title or Position: DENTIST
Credential: DDS
Phone: 269-423-7866