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General NPI Number Information
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NPI Number | 1285688531
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Entity Type | Individual
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Provider Name | PAUL A AGYEKUM SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13800 LIVERNOIS AVE
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City | DETROIT
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State | MI
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Zip | 48238-4510
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Country | US
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Telephone | 313-491-2200
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Fax | 313-491-2210
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Provider Business Mailing Address
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Address Line | 2931 RAMBLING WAY
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-1049
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Country | US
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Telephone | 248-338-7120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12292
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License Number State | MI
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