Healthcare Provider Details

I. General information

NPI: 1639214299
Provider Name (Legal Business Name): WHITE OAK DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N M 52
STOCKBRIDGE MI
49285-9766
US

IV. Provider business mailing address

2600 N M 52
STOCKBRIDGE MI
49285-9766
US

V. Phone/Fax

Practice location:
  • Phone: 517-851-8902
  • Fax: 517-851-9241
Mailing address:
  • Phone: 517-851-8902
  • Fax: 517-851-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18924
License Number StateMI

VIII. Authorized Official

Name: DR. JOURAISH M DAOUD
Title or Position: OWNER
Credential: DMD
Phone: 517-851-8902