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General NPI Number Information
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NPI Number | 1598349680
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Entity Type | Organization
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Legal Business Name | PRIME DENTISTRY SOUTHFIELD PLLC
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 23077 GREENFIELD RD STE 210
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3750
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Country | US
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Telephone | 248-552-0223
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Fax |
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Provider Business Mailing Address
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Address Line | 837 FOREST AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6452
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Country | US
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Telephone | 586-651-2155
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Fax |
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Authorized Official
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Title or Position | COO
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Name | THERESA LABRANCHE
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Credential |
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Telephone | 586-651-2155
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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 |
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License Number State |
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