MEDICARE: DENTAL HEALTH GROUP OF MICHGIAN

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	122300000X	Dentist

General Provider Information

NPI Number	:	1144435603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH GROUP OF MICHGIAN

Provider Business Mailing Address
First Line	:	20295 NW 2ND AVE
Second Line	:	SUITE 210
City	:	MIAMI
State	:	FL
Zip	:	33169-2550
Country	:	US
Telephone Number	:	305-652-6313
Fax Number	:	305-652-9940

Provider Business Practice Location Address
First Line	:	3257 FORT ROAD
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146
Country	:	US
Telephone Number	:	313-383-2270
Fax Number	:	313-383-2558

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT ALAN BRODY
Credential	:
Telephone Number	:	305-652-6313

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	05/20/2008

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