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NPI Code Detail

MEDICARE: SUPER DENTAL, PC

MEDICARE: SUPER DENTAL, PC
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
1122300000XDentist

General Provider Information

NPI Number : 1043460330
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPER DENTAL, PC
Provider Business Mailing Address
First Line : PO BOX 38367
Second Line :
City : DETROIT
State : MI
Zip : 48238
Country : US
Telephone Number : 313-863-2800
Fax Number :
Provider Business Practice Location Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number : 313-863-2800
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DR. SANDRA A LOREDO
Credential : DDS
Telephone Number : 313-863-2800
Provider Enumeration Date : 09/24/2008
Last Update Date : 09/24/2008

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Directions to “SUPER DENTAL, PC ” Practice Location

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