MEDICARE: VERTEX FAMILY DENTAL OF CLINTON TOWN SHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1003633199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERTEX FAMILY DENTAL OF CLINTON TOWN SHIP

Provider Business Mailing Address
First Line	:	19189 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19189 15 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-2508
Country	:	US
Telephone Number	:	586-329-5391
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ARBEN ULDEDAJ
Credential	:
Telephone Number	:	586-329-5391

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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