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General NPI Number Information
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NPI Number | 1467662841
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Entity Type | Organization
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Legal Business Name | MICHIGAN DENTUREAND IMPLANT CENTER
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26001 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1440
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Country | US
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Telephone | 313-592-1100
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Fax | 313-592-0061
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Provider Business Mailing Address
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Address Line | 26001 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1440
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Country | US
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Telephone | 313-592-1100
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Fax | 313-592-0061
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LAWRENCE J VERNIER
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Credential | DDS
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Telephone | 313-592-1100
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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 | 14476
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License Number State | MI
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