Healthcare Provider Details

I. General information

NPI: 1346828068
Provider Name (Legal Business Name): PERIODONTIC AND IMPLANTOLOGY SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 03/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33505 W 14 MILE RD STE 70
FARMINGTON HILLS MI
48331-1588
US

IV. Provider business mailing address

33505 W 14 MILE RD STE 70
FARMINGTON HILLS MI
48331-1588
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-1034
  • Fax:
Mailing address:
  • Phone: 248-851-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN M FRANKLIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 248-851-1034