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General NPI Number Information
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NPI Number | 1770752925
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Entity Type | Organization
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Legal Business Name | PERIODONTAL SPECIALISTS GROUP
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 8619 WEST GRAND RIVER SUITE F
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City | BRIGHTON
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State | MI
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Zip | 48116
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Country | US
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Telephone | 810-227-7427
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Fax | 810-227-8248
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Provider Business Mailing Address
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Address Line | 8619 WEST GRAND RIVER SUITE F
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City | BRIGHTON
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State | MI
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Zip | 48116
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Country | US
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Telephone | 810-227-7427
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Fax | 810-227-8248
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN FREDERICK SILVERSTON
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Credential | DDS MS
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Telephone | 810-227-7427
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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 | 10031
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14883
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9095
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License Number State | MI
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