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General NPI Number Information
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NPI Number | 1891191813
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Entity Type | Organization
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Legal Business Name | WATERFORD HEARING CENTER, LLC
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 5907 DIXIE HWY
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City | CLARKSTON
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State | MI
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Zip | 48346-3361
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Country | US
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Telephone | 248-599-7448
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Fax |
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Provider Business Mailing Address
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Address Line | 3086 CAIRNCROSS DR
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City | OAKLAND
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State | MI
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Zip | 48363-2702
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Country | US
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Telephone | 248-599-7448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC PETTERSON
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Credential |
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Telephone | 248-599-7448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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