Healthcare Provider Details

I. General information

NPI: 1629510482
Provider Name (Legal Business Name): DDS-TAPESTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 200
DETROIT MI
48214-3730
US

IV. Provider business mailing address

7310 WOODWARD AVE STE 400
DETROIT MI
48202-3165
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-2895
  • Fax: 313-244-0661
Mailing address:
  • Phone: 313-576-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS ROSE
Title or Position: OWNER
Credential: DMD
Phone: 248-534-6769