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General NPI Number Information
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NPI Number | 1548992464
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Entity Type | Individual
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Provider Name | PETAR SIMOSKI DDS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 39555 W 10 MILE RD STE 306
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City | NOVI
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State | MI
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Zip | 48375-2950
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Country | US
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Telephone | 248-442-7305
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Fax |
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Provider Business Mailing Address
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Address Line | 3594 MILDRED AVE
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-4262
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Country | US
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Telephone | 248-296-9755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901601461
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License Number State | MI
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