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General NPI Number Information
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NPI Number | 1053748889
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Entity Type | Organization
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Legal Business Name | DENTAL HYGIENE VISITING SERVICES
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Dates
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Enumeration Date | 10/12/2013
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Last Update Date | 10/12/2013
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Provider Practice Location Address
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Address Line | 38 ADELAIDE ST
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City | DETROIT
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State | MI
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Zip | 48201-3111
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Country | US
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Telephone | 313-407-1400
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Fax | 313-784-9136
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Provider Business Mailing Address
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Address Line | 38 ADELAIDE ST
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City | DETROIT
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State | MI
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Zip | 48201-3111
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Country | US
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Telephone | 313-407-1400
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Fax | 313-784-9136
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Authorized Official
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Title or Position | OWNER-HYGIENIST
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Name | MS. LESLIE LORAY MCCLENIC
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Credential | RDH
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Telephone | 313-407-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902010375
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License Number State | MI
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