Healthcare Provider Details

I. General information

NPI: 1376472076
Provider Name (Legal Business Name): MOSAIC DENTAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E BIG BEAVER RD STE D
TROY MI
48083-1432
US

IV. Provider business mailing address

650 E BIG BEAVER RD STE D
TROY MI
48083-1432
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-2270
  • Fax: 248-528-2377
Mailing address:
  • Phone: 248-528-2270
  • Fax: 248-528-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEB THOMASON
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-528-2270