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General NPI Number Information
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NPI Number | 1386050664
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF DETROIT MERCY
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD
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City | DETROIT
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State | MI
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Zip | 48208-2576
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Country | US
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Telephone | 313-993-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 MARTIN LUTHER KING JR BLVD
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City | DETROIT
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State | MI
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Zip | 48208-2576
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Country | US
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Telephone | 313-993-1000
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR AEGD
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Name | DR. MARY PARISE
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Credential | DDS
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Telephone | 313-494-6907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021308
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License Number State | MI
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