Healthcare Provider Details

I. General information

NPI: 1215215298
Provider Name (Legal Business Name): DELIVER DENTAL SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 W ALEXANDRINE ST 3RD FLOOR
DETROIT MI
48201-2015
US

IV. Provider business mailing address

79 W ALEXANDRINE ST
DETROIT MI
48201-2015
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-2535
  • Fax: 800-861-4061
Mailing address:
  • Phone: 313-576-2535
  • Fax: 800-861-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TOM ROSE
Title or Position: RECEIVABLES MANAGER
Credential:
Phone: 708-205-1283