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General NPI Number Information
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NPI Number | 1225389208
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Entity Type | Organization
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Legal Business Name | ULLA CROUSE PLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 8641 W GRAND RIVER AVE STE 9
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City | BRIGHTON
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State | MI
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Zip | 48116-4330
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Country | US
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Telephone | 810-229-8200
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Fax | 810-220-5021
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Provider Business Mailing Address
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Address Line | 8641 W GRAND RIVER AVE STE 9
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City | BRIGHTON
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State | MI
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Zip | 48116-4330
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Country | US
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Telephone | 810-229-8200
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Fax | 810-220-5021
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Authorized Official
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Title or Position | OWNER
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Name | ULLA CROUSE
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Credential | DDS, PHD
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Telephone | 810-229-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D019249
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License Number State | MI
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