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General NPI Number Information
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NPI Number | 1629536388
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Entity Type | Organization
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Legal Business Name | OVAL DENTAL GROUP P C
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 32653 CHERRY HILL RD
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City | WESTLAND
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State | MI
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Zip | 48186-5294
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Country | US
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Telephone | 734-728-6166
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Fax | 734-728-6176
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Provider Business Mailing Address
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Address Line | 32653 CHERRY HILL RD
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City | WESTLAND
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State | MI
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Zip | 48186-5294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAMILO MACHADO
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Credential | DMD
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Telephone | 641-432-5621
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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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