MEDICARE: DIPILLA BIOMIMETIC DENTISTRY PLLC

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	:	1134937642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIPILLA BIOMIMETIC DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	600 N OLD WOODWARD AVE STE 201
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-1318
Country	:	US
Telephone Number	:	313-246-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N OLD WOODWARD AVE STE 201
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-1318
Country	:	US
Telephone Number	:	313-246-8288
Fax Number	:	248-266-9319

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	JENNIFER AUSILIO
Credential	:
Telephone Number	:	586-615-6865

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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