Healthcare Provider Details

I. General information

NPI: 1588962351
Provider Name (Legal Business Name): NORTH OAKS DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 ROCHESTER RD
ROYAL OAK MI
48073-3553
US

IV. Provider business mailing address

3213 ROCHESTER RD
ROYAL OAK MI
48073-3553
US

V. Phone/Fax

Practice location:
  • Phone: 248-629-1830
  • Fax:
Mailing address:
  • Phone: 248-629-1830
  • Fax: 248-629-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALVIN DABOUL
Title or Position: DR
Credential:
Phone: 248-629-1830