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General NPI Number Information
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NPI Number | 1407184641
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Entity Type | Organization
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Legal Business Name | MODERN AMERICAN DENTAL CLINIC P. C.
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 14350 W WARREN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-1459
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Country | US
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Telephone | 313-582-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 14350 W WARREN AVE
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City | DEARBORN
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State | MI
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Zip | 48126-1459
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Country | US
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Telephone | 313-582-1919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NABIL BERRY
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Credential | DDS
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Telephone | 313-582-1919
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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 | 015159 MI
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License Number State | MI
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