Healthcare Provider Details

I. General information

NPI: 1881746907
Provider Name (Legal Business Name): UDAY FAMILY DENTISTRY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 MACOMB ST
GROSSE ILE MI
48138-1577
US

IV. Provider business mailing address

8930 MACOMB ST
GROSSE ILE MI
48138-1577
US

V. Phone/Fax

Practice location:
  • Phone: 734-676-2288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18117
License Number StateMI

VIII. Authorized Official

Name: DR. MATTHEW UDAY
Title or Position: PRESIDENT
Credential: DDS
Phone: 734-676-2288