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General NPI Number Information
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NPI Number | 1619141256
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Entity Type | Organization
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Legal Business Name | GEORGE ATWAN DENTISTRY LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 2735 BENSTEIN RD
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48390-1101
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Country | US
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Telephone | 248-624-3010
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Fax | 248-624-5886
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Provider Business Mailing Address
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Address Line | 2735 BENSTEIN RD
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48390-1101
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Country | US
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Telephone | 248-624-3010
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Fax | 248-624-5886
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Authorized Official
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Title or Position | MANAGER
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Name | DOREEN L ZAFFER
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Credential |
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Telephone | 248-624-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 291016802
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901016989
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License Number State | MI
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