Healthcare Provider Details

I. General information

NPI: 1992574131
Provider Name (Legal Business Name): TINGLING ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 W 12 MILE RD
SOUTHFIELD MI
48076-5415
US

IV. Provider business mailing address

17521 ALTA VISTA DR
SOUTHFIELD MI
48075-1935
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-0530
  • Fax:
Mailing address:
  • Phone: 917-667-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL GROSS
Title or Position: CEO
Credential: DDS MS
Phone: 516-241-0318