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General NPI Number Information
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NPI Number | 1356865174
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Entity Type | Organization
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Legal Business Name | ICARE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2900 UNION LAKE RD STE 105
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City | COMMERCE TWP
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State | MI
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Zip | 48382-3550
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Country | US
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Telephone | 248-363-5900
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Fax | 248-363-4917
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Provider Business Mailing Address
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Address Line | 2900 UNION LAKE RD STE 105
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City | COMMERCE TWP
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State | MI
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Zip | 48382-3550
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Country | US
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Telephone | 248-363-5900
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Fax | 248-363-4917
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | LAUREN HANEY
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Credential | RDH
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Telephone | 248-363-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901019256
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License Number State | MI
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