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NPI Code Detail

MEDICARE: WOMACK DENTAL PC.

MEDICARE: WOMACK 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 : 1073853453
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOMACK DENTAL PC.
Provider Business Mailing Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number : 313-342-1997
Fax Number : 313-416-1405
Provider Business Practice Location Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number : 313-342-1997
Fax Number : 313-416-1405
Authorized Official
Title or Position : MANAGER
Name : KATIVIA FIELDS
Credential :
Telephone Number : 248-392-6005
Provider Enumeration Date : 02/22/2013
Last Update Date : 02/22/2013

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Directions to “WOMACK DENTAL PC. ” Practice Location

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