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General NPI Number Information
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NPI Number | 1528139540
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Entity Type | Organization
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Legal Business Name | DENTAL CARE MANAGEMENT, INC.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15311 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48235-3723
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Country | US
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Telephone | 313-838-0490
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Fax |
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Provider Business Mailing Address
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Address Line | 15311 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48235-3723
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Country | US
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Telephone | 313-838-0490
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. JOHN ILITCH
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Credential | D.D.S.
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Telephone | 313-838-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 14256
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License Number State | MI
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