Healthcare Provider Details

I. General information

NPI: 1386105070
Provider Name (Legal Business Name): CAIUS CORETCHI MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 PENNSYLVANIA RD
SOUTHGATE MI
48195-2167
US

IV. Provider business mailing address

14600 PENNSYLVANIA RD
SOUTHGATE MI
48195-2167
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-1520
  • Fax: 734-571-6671
Mailing address:
  • Phone: 734-675-1520
  • Fax: 734-571-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901600577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: