MEDICARE: DAVID J. POWELL D.D.S, 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
1	261QD0000X	Dental Clinic/Center	16128	MI

General Provider Information

NPI Number	:	1245404128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J. POWELL D.D.S, PC

Provider Business Mailing Address
First Line	:	2020 CHESLEY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4818
Country	:	US
Telephone Number	:	586-979-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 CHESLEY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4818
Country	:	US
Telephone Number	:	586-979-0300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID J POWELL
Credential	:	DDS
Telephone Number	:	586-979-0300

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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