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General NPI Number Information
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NPI Number | 1154653319
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Entity Type | Organization
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Legal Business Name | QUALITAS DENTAL GROUP, PC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 17199 N LAUREL PARK DR SUITE 200
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City | LIVONIA
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State | MI
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Zip | 48152-2683
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Country | US
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Telephone | 734-432-9849
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Fax | 734-953-0412
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Provider Business Mailing Address
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Address Line | 17199 N LAUREL PARK DR SUITE 200
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City | LIVONIA
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State | MI
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Zip | 48152-2683
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Country | US
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Telephone | 734-432-9849
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Fax | 734-953-0412
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL K TIMMONS
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Credential |
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Telephone | 734-432-9849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | MI
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