Healthcare Provider Details

I. General information

NPI: 1285252874
Provider Name (Legal Business Name): PLYMOUTH ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9416 S MAIN ST STE 212
PLYMOUTH MI
48170-4148
US

IV. Provider business mailing address

9416 S MAIN ST STE 212
PLYMOUTH MI
48170-4148
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-8844
  • Fax:
Mailing address:
  • Phone: 734-459-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: STEVE J. VLAHAKIS
Title or Position: OWNER
Credential: DDS
Phone: 734-459-8844