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General NPI Number Information
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NPI Number | 1619348471
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Entity Type | Organization
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Legal Business Name | MICHIGAN DENTAL PROVIDERS, P.C.
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 39833 TRADITIONS DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-9498
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Country | US
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Telephone | 248-344-1913
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Fax |
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Provider Business Mailing Address
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Address Line | 7160 DALLAS PKWY STE 400
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City | PLANO
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State | TX
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Zip | 75024-7111
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Country | US
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Telephone | 248-344-1913
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Fax |
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Authorized Official
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Title or Position | MANAGER CREDENTIALING
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Name | RACHEL NITTINGER
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Credential |
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Telephone | 972-755-0816
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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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