MEDICARE: MICHAEL ANTHONY GAJEWSKI DDS

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	1223G0001X	General Practice Dentistry	012899	MI

General Provider Information

NPI Number	:	1265545230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANTHONY GAJEWSKI DDS

Provider Business Mailing Address
First Line	:	42850 GARFIELD RD
Second Line	:	SUITE 103
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5026
Country	:	US
Telephone Number	:	586-263-0222
Fax Number	:	586-263-0662

Provider Business Practice Location Address
First Line	:	42850 GARFIELD RD
Second Line	:	SUITE 103
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-5026
Country	:	US
Telephone Number	:	586-263-0222
Fax Number	:	586-263-0662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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