Healthcare Provider Details

I. General information

NPI: 1942135322
Provider Name (Legal Business Name): MARIA GERGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33080 GARFIELD RD
FRASER MI
48026-1867
US

IV. Provider business mailing address

56516 ASHBROOKE DR W
SHELBY TOWNSHIP MI
48316-5527
US

V. Phone/Fax

Practice location:
  • Phone: 586-914-0518
  • Fax:
Mailing address:
  • Phone: 586-914-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: