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General NPI Number Information
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NPI Number | 1033548201
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Entity Type | Organization
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Legal Business Name | CONVENIENT BR PC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 2120 GRAND RIVER ANX SUITE 100
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City | BRIGHTON
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State | MI
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Zip | 48114-7392
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Country | US
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Telephone | 810-225-0022
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Fax | 810-225-0033
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Provider Business Mailing Address
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Address Line | 2120 GRAND RIVER ANX SUITE 100
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City | BRIGHTON
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State | MI
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Zip | 48114-7392
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Country | US
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Telephone | 810-225-0022
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Fax | 810-225-0033
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Authorized Official
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Title or Position | ASST. TO GEN. MGR
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Name | MRS. CHRISTINE R MASCHKE
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Credential |
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Telephone | 248-542-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901019426
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License Number State | MI
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