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General NPI Number Information
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NPI Number | 1851751150
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Entity Type | Organization
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Legal Business Name | THOMAS VERALDI, DMD RESIDENCY AND HOSPITAL PRACTICE, PC
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 79 W ALEXANDRINE ST 3RD FLR
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City | DETROIT
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State | MI
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Zip | 48201-2015
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Country | US
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Telephone | 313-833-2895
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Fax | 313-263-4332
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Provider Business Mailing Address
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Address Line | 7310 WOODWARD AVE STE 400
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City | DETROIT
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State | MI
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Zip | 48202-3165
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Country | US
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Telephone | 313-833-2895
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Fax | 313-263-4332
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. THOMAS VERALDI
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Credential | DDS
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Telephone | 313-833-2895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901021771
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License Number State | MI
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