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General NPI Number Information
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NPI Number | 1295902302
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE DENTAL
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 58047 VAN DYKE RD SUITE #101
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City | WASHINGTON TWP
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State | MI
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Zip | 48094-4000
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Country | US
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Telephone | 586-207-6013
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Fax | 586-207-6300
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Provider Business Mailing Address
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Address Line | 58047 VAN DYKE RD SUITE #101
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City | WASHINGTON TWP
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State | MI
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Zip | 48094-4000
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Country | US
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Telephone | 586-207-6013
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Fax | 586-207-6300
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS MICHAEL DAVIDSON
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Credential | DDS
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Telephone | 586-207-6013
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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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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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