Healthcare Provider Details

I. General information

NPI: 1427490838
Provider Name (Legal Business Name): MICHAEL STEVEN DANELIA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 W 10 MILE RD
SOUTHFIELD MI
48075-2654
US

IV. Provider business mailing address

5345 TEQUESTA DR
WEST BLOOMFIELD MI
48323-2351
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-6304
  • Fax:
Mailing address:
  • Phone: 248-763-0538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021033
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: