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General NPI Number Information
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NPI Number | 1295441822
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Entity Type | Organization
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Legal Business Name | MIKE KOSTAKOS, DDS, P.C.
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 20307 W 12 MILE RD STE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5407
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Country | US
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Telephone | 248-559-1220
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Fax | 248-559-4300
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Provider Business Mailing Address
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Address Line | 20307 W 12 MILE RD STE 101
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5407
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Country | US
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Telephone | 248-559-1220
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Fax | 248-559-4300
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | WALA SALAMA
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Credential |
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Telephone | 248-559-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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