Healthcare Provider Details

I. General information

NPI: 1467509737
Provider Name (Legal Business Name): DAVID MICHAEL REPASKY D.D.S., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33030 VAN BORN RD
WAYNE MI
48184-2453
US

IV. Provider business mailing address

709 CAMBRIDGE ST
YPSILANTI MI
48197-2127
US

V. Phone/Fax

Practice location:
  • Phone: 734-727-7050
  • Fax: 734-727-7005
Mailing address:
  • Phone: 734-483-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901010538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: