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NPI Code Detail

MEDICARE: GATEWAY DENTAL CARE, PLC

MEDICARE: GATEWAY DENTAL CARE, PLC
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
1122300000XDentist2901017587MI

General Provider Information

NPI Number : 1265984041
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY DENTAL CARE, PLC
Provider Business Mailing Address
First Line : 25660 PONTIAC TRL
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-8046
Country : US
Telephone Number : 248-446-2700
Fax Number :
Provider Business Practice Location Address
First Line : 51611 TEN MILE RD
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-9720
Country : US
Telephone Number : 248-278-0031
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MICHELLE CONFORTI
Credential : DDS
Telephone Number : 248-446-2700
Provider Enumeration Date : 10/27/2016
Last Update Date : 10/27/2016

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Directions to “GATEWAY DENTAL CARE, PLC ” Practice Location

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