Healthcare Provider Details

I. General information

NPI: 1275271512
Provider Name (Legal Business Name): DANIELA IVANA NAUMOVSKI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6647
  • Fax:
Mailing address:
  • Phone: 313-499-4962
  • Fax: 313-499-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601485
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901601485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: