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General NPI Number Information
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NPI Number | 1992006738
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Entity Type | Individual
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Provider Name | MICHAEL CASEY KAKAREKA DDS
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Gender | Male
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 6760 ALLEN RD STE 101
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City | ALLEN PARK
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State | MI
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Zip | 48101-2062
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Country | US
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Telephone | 313-928-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 28015 LORRAINE AVE
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City | WARREN
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State | MI
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Zip | 48093-4921
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Country | US
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Telephone | 586-453-4061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901020288
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License Number State | MI
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