Healthcare Provider Details

I. General information

NPI: 1063802338
Provider Name (Legal Business Name): MADISON HEIGHTS DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28755 DEQUINDRE RD
MADISON HTS MI
48071-3005
US

IV. Provider business mailing address

28755 DEQUINDRE RD
MADISON HTS MI
48071-3005
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-6305
  • Fax: 248-569-7914
Mailing address:
  • Phone: 248-569-6305
  • Fax: 248-569-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14188
License Number StateMI

VIII. Authorized Official

Name: DR. NOAH LEVI
Title or Position: DOCTOR
Credential: DDS
Phone: 248-569-6304