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General NPI Number Information
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NPI Number | 1760153563
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Entity Type | Organization
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Legal Business Name | MORNING STAR DENTAL
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 8292 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48093-2737
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Country | US
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Telephone | 586-393-1516
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Fax | 586-393-1518
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Provider Business Mailing Address
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Address Line | PO BOX 3756
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City | SOUTHFIELD
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State | MI
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Zip | 48037-3756
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Country | US
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Telephone | 586-393-1516
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCUS L PAULUS
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Credential | DDS
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Telephone | 586-393-1516
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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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