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General NPI Number Information
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NPI Number | 1609411560
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Entity Type | Organization
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Legal Business Name | GD MI PLLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 24033 MEADOWBROOK RD
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City | NOVI
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State | MI
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Zip | 48375-3456
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Country | US
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Telephone | 248-305-1689
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Fax |
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Provider Business Mailing Address
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Address Line | 22610 SHEVINGTON DR
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City | SOUTHFIELD
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State | MI
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Zip | 48034-6213
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Country | US
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Telephone | 412-849-3919
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | FRED WEINBERG
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Credential |
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Telephone | 412-849-3919
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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 |
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License Number State |
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