Healthcare Provider Details

I. General information

NPI: 1497878375
Provider Name (Legal Business Name): WB DENTAL CENTERS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1315
US

IV. Provider business mailing address

45055 COBBLESTONE
NOVI MI
48377-1395
US

V. Phone/Fax

Practice location:
  • Phone: 248-681-4660
  • Fax: 248-681-3610
Mailing address:
  • Phone: 248-669-6608
  • Fax: 248-681-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018302
License Number StateMI

VIII. Authorized Official

Name: DR. WARREN CHARLES BLACK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 248-669-6608