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General NPI Number Information
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NPI Number | 1376879742
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Entity Type | Organization
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Legal Business Name | DISTRICT DENTAL CENTER
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 15064 HOUSTON WHITTIER ST
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City | DETROIT
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State | MI
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Zip | 48205-4127
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Country | US
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Telephone | 313-535-5200
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Fax | 313-535-0011
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Provider Business Mailing Address
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Address Line | 15064 HOUSTON WHITTIER ST
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City | DETROIT
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State | MI
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Zip | 48205-4127
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Country | US
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Telephone | 313-535-5200
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Fax | 313-535-0011
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MAVIS D PHILLIPS
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Credential |
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Telephone | 313-535-5200
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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 | 2901014040
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License Number State | MI
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