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General NPI Number Information
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NPI Number | 1033166996
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Entity Type | Organization
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Legal Business Name | ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 31410 NORTHWESTERN HWY STE. C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2563
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Country | US
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Telephone | 248-737-1360
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Fax |
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Provider Business Mailing Address
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Address Line | 31410 NORTHWESTERN HWY STE C
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2563
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Country | US
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Telephone | 248-737-1360
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Fax |
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Authorized Official
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Title or Position | PARTNER DOCTOR
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Name | DR. GERALD C DIETZ JR.
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Credential | DDS
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Telephone | 248-647-7930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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