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General NPI Number Information
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NPI Number | 1245045541
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Entity Type | Organization
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Legal Business Name | PRIME DENTAL CARE PLLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 24650 VAN DYKE AVE
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City | CENTER LINE
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State | MI
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Zip | 48015-1321
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Country | US
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Telephone | 586-757-2136
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Fax |
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Provider Business Mailing Address
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Address Line | 24650 VAN DYKE AVE
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City | CENTER LINE
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State | MI
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Zip | 48015-1321
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Country | US
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Telephone | 586-757-2136
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | HUSSEIN NASSER
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Credential |
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Telephone | 313-699-1716
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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 |
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