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General NPI Number Information
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NPI Number | 1528131364
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF MICHIGAN, P.C.
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 3415 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-5063
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Country | US
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Telephone | 248-519-1919
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Fax | 248-519-1920
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Provider Business Mailing Address
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Address Line | 3415 LIVERNOIS RD
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City | TROY
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State | MI
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Zip | 48083-5063
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Country | US
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Telephone | 248-519-1919
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Fax | 248-519-1920
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. CRAIG P GOLDIN
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Credential | DDS
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Telephone | 248-519-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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