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General NPI Number Information
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NPI Number | 1265735633
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Entity Type | Organization
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Legal Business Name | WARRENDALE DENTAL CENTER PC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 6501 GREENFIELD RD #201
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City | DETROIT
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State | MI
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Zip | 48228-4780
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Country | US
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Telephone | 313-584-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 GREENFIELD RD #201
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City | DETROIT
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State | MI
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Zip | 48228-4780
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MRS. TRACEY ROBINSON
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Credential |
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Telephone | 313-584-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number | 2901011576
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License Number State | MI
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