Healthcare Provider Details

I. General information

NPI: 1891790929
Provider Name (Legal Business Name): JAMES MICHAEL SOCKOLOSKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35000 FORD RD STE 6
WESTLAND MI
48185-3719
US

IV. Provider business mailing address

45139 BROOKSIDE CT
PLYMOUTH MI
48170-3846
US

V. Phone/Fax

Practice location:
  • Phone: 734-326-2030
  • Fax:
Mailing address:
  • Phone: 734-459-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: