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General NPI Number Information
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NPI Number | 1063690683
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CENTER PC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 3912 18 MILE ROAD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314
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Country | US
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Telephone | 586-264-3200
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Fax | 586-264-3241
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Provider Business Mailing Address
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Address Line | 3912 18 MILE ROAD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314
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Country | US
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Telephone | 586-264-3200
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Fax | 586-264-3241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDUARDO G REGALADO JR.
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Credential | DDS
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Telephone | 586-264-3200
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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 | 018718
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016079
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 107660
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License Number State | MI
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