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General NPI Number Information
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NPI Number | 1598943052
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Entity Type | Organization
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Legal Business Name | PERIODONTIC PLLC
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 22801 NEWMAN ST.
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City | DEARBORN
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State | MI
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Zip | 48124-1740
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Country | US
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Telephone | 313-274-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 22801 NEWMAN ST.
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City | DEARBORN
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State | MI
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Zip | 48124-1740
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Country | US
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Telephone | 313-274-8522
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID G DARANY
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Credential | DDS,MS
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Telephone | 313-274-8522
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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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