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General NPI Number Information
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NPI Number | 1528064771
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Entity Type | Organization
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Legal Business Name | A DENTAL CENTER-DOWNRIVER
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 17128 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-6619
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Country | US
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Telephone | 734-281-3200
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Fax | 734-281-3890
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Provider Business Mailing Address
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Address Line | 17128 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-6619
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Country | US
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Telephone | 734-281-3200
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Fax | 734-281-3890
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Authorized Official
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Title or Position | BILLING
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Name | DR. HOWARD POTOCSKY
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Credential | D.D.S
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Telephone | 734-281-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 17288
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License Number State | MI
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