Healthcare Provider Details

I. General information

NPI: 1629256094
Provider Name (Legal Business Name): PERIODONTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

22801 NEWMAN ST
DEARBORN MI
48124-2200
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-1034
  • Fax: 248-851-7065
Mailing address:
  • Phone: 313-274-8522
  • Fax: 313-274-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID G DARANY
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 313-274-8522