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General NPI Number Information
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NPI Number | 1275023897
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Entity Type | Organization
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Legal Business Name | PEARL DENTAL GROUP PLLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 9324 CONANT ST STE C
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3506
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Country | US
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Telephone | 313-870-9423
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Fax | 313-870-9424
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Provider Business Mailing Address
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Address Line | 9324 CONANT ST STE C
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3506
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Country | US
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Telephone | 313-870-9423
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Fax | 313-870-9424
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS AMANDA JANE ZEHEL
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Credential |
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Telephone | 586-563-4626
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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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