Healthcare Provider Details

I. General information

NPI: 1275636342
Provider Name (Legal Business Name): NEW BOSTON DENTAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37228 HURON RIVER DR
NEW BOSTON MI
48164-0217
US

IV. Provider business mailing address

37228 HURON RIVER DR PO BOX 217
NEW BOSTON MI
48164-0217
US

V. Phone/Fax

Practice location:
  • Phone: 734-753-4300
  • Fax: 734-753-5139
Mailing address:
  • Phone: 734-753-4300
  • Fax: 734-753-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901014931
License Number StateMI

VIII. Authorized Official

Name: DR. DARIO MERLOS
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 734-753-4300