Healthcare Provider Details

I. General information

NPI: 1043760812
Provider Name (Legal Business Name): ENBRITE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E POTTAWATAMIE ST
TECUMSEH MI
49286-2016
US

IV. Provider business mailing address

416 E POTTAWATAMIE ST
TECUMSEH MI
49286-2016
US

V. Phone/Fax

Practice location:
  • Phone: 517-301-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT SCHUSTER
Title or Position: CFO
Credential:
Phone: 248-790-5650