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General NPI Number Information
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NPI Number | 1689081903
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Entity Type | Organization
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Legal Business Name | THE NEW GLOBAL DENTISTRY, PLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 1201 N MILFORD RD
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City | MILFORD
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State | MI
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Zip | 48381-1070
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Country | US
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Telephone | 248-363-2000
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Fax | 248-636-4730
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Provider Business Mailing Address
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Address Line | 1201 N MILFORD RD
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City | MILFORD
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State | MI
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Zip | 48381-1070
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Country | US
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Telephone | 248-363-2000
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Fax | 248-636-4730
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CARMEN M O'MALLEY
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Credential | DENTIST
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Telephone | 248-363-2000
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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 | 19031
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License Number State | MI
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