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General NPI Number Information
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NPI Number | 1922272152
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Entity Type | Organization
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Legal Business Name | PAUL DENTAL GROUP, PC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 14521 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2446
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Country | US
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Telephone | 313-839-7999
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Fax | 313-839-0639
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Provider Business Mailing Address
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Address Line | 14521 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2446
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Country | US
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Telephone | 313-839-7999
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Fax | 313-839-0639
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. PAUL AGYEKUM
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Credential | DDS
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Telephone | 313-839-7900
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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 | 12292
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License Number State | MI
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