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General NPI Number Information
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NPI Number | 1144579467
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 69089 N MAIN ST
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City | RICHMOND
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State | MI
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Zip | 48062-1146
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Country | US
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Telephone | 586-727-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S MILL ST STE 200
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City | NEW CASTLE
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State | PA
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Zip | 16101-3613
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Country | US
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Telephone | 724-698-2500
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHAMS HAMAMA
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Credential |
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Telephone | 586-727-5898
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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 |
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License Number State |
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