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NPI Code Detail

MEDICARE: DR. MARY DARGHALI D.D.S.

MEDICARE: DR. MARY DARGHALI D.D.S.
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
1122300000XDentist2901021545MI

General Provider Information

NPI Number : 1184005852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY DARGHALI D.D.S.
Provider Business Mailing Address
First Line : 122 RELLA RAE AVE
Second Line :
City : MARYSVILLE
State : MI
Zip : 48040-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4018 LAPEER RD
Second Line :
City : PORT HURON
State : MI
Zip : 48060-7775
Country : US
Telephone Number : 810-987-3823
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2015
Last Update Date : 05/04/2023

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