Healthcare Provider Details

I. General information

NPI: 1396194593
Provider Name (Legal Business Name): THUMBS UP DENTAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6668 BERNIE KOHLER DR
NORTH BRANCH MI
48461-8885
US

IV. Provider business mailing address

4450 W WALTON BLVD
WATERFORD MI
48329-4093
US

V. Phone/Fax

Practice location:
  • Phone: 810-688-3047
  • Fax: 810-688-3109
Mailing address:
  • Phone: 248-674-0495
  • Fax: 248-674-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14179
License Number StateMI

VIII. Authorized Official

Name: MELISSA SCHROEDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-674-0495