Healthcare Provider Details

I. General information

NPI: 1477040087
Provider Name (Legal Business Name): ALL ABOUT ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E 14 MILE RD STE 3/4
WARREN MI
48092-4369
US

IV. Provider business mailing address

4600 E 14 MILE RD STE 3/4
WARREN MI
48092-4369
US

V. Phone/Fax

Practice location:
  • Phone: 586-999-9000
  • Fax: 586-999-8000
Mailing address:
  • Phone: 586-999-9000
  • Fax: 586-999-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901022120
License Number StateMI

VIII. Authorized Official

Name: DR. RAPHAEL R. PUTRUS
Title or Position: PRESIDENT, CHIEF ORTHODONTIST
Credential: DMD
Phone: 586-999-9000