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General NPI Number Information
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NPI Number | 1003985169
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Entity Type | Organization
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Legal Business Name | PDC MANAGEMEN
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5831 W VERNOR HWY
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City | DETROIT
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State | MI
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Zip | 48209-2159
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Country | US
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Telephone | 313-842-8300
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Fax | 313-842-8530
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Provider Business Mailing Address
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Address Line | 5831 W VERNOR HWY
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City | DETROIT
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State | MI
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Zip | 48209-2159
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Country | US
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Telephone | 313-842-8300
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Fax | 313-842-8530
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Authorized Official
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Title or Position | OFFICER
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Name | ANWAR ELIA
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Credential |
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Telephone | 313-842-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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