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General NPI Number Information
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NPI Number | 1760935993
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Entity Type | Organization
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Legal Business Name | MONOSETA C. BURWELL, D.M.D., P.C.
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Dates
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Enumeration Date | 07/23/2016
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Last Update Date | 07/23/2016
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Provider Practice Location Address
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Address Line | 18951 W 12 MILE RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2575
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Country | US
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Telephone | 248-353-4747
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Fax | 248-353-2297
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Provider Business Mailing Address
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Address Line | 18951 W 12 MILE RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2575
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Country | US
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Telephone | 248-353-4747
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Fax | 248-353-2297
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. MONOSETA COVINGTON-BURWELL
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Credential | D.M.D.
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Telephone | 248-353-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901013087
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License Number State | MI
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