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General NPI Number Information
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NPI Number | 1740303536
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Entity Type | Organization
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Legal Business Name | DOVE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 37540 GRATIOT SUITE 101
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-2795
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Country | US
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Telephone | 586-465-1433
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Fax | 586-465-6258
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Provider Business Mailing Address
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Address Line | 37540 GRATIOT SUITE 101
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-2795
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Country | US
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Telephone | 586-465-1433
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Fax | 586-465-6258
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Authorized Official
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Title or Position | DENTIST PRESIDENT
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Name | DR. JAMES A WENTURINE
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Credential | DDS
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Telephone | 586-465-1433
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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 | 2901014271
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License Number State | MI
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