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General NPI Number Information
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NPI Number | 1992574131
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Entity Type | Organization
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Legal Business Name | TINGLING ORTHODONTICS PLLC
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 20400 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5415
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Country | US
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Telephone | 248-352-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 17521 ALTA VISTA DR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1935
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Country | US
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Telephone | 917-667-8738
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DANIEL GROSS
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Credential | DDS MS
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Telephone | 516-241-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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