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NPI Code Detail

MEDICARE: GENTLE DENTAL PLYMOUTH ROAD PLLC

MEDICARE: GENTLE DENTAL PLYMOUTH ROAD PLLC
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
1122300000XDentist

General Provider Information

NPI Number : 1336264324
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENTLE DENTAL PLYMOUTH ROAD PLLC
Provider Business Mailing Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20720 PLYMOUTH RD
Second Line :
City : DETROIT
State : MI
Zip : 48228-1275
Country : US
Telephone Number : 313-273-3380
Fax Number :
Authorized Official
Title or Position : INSURANCE DIRECTOR
Name : MIKE COLE
Credential :
Telephone Number : 727-726-1611
Provider Enumeration Date : 03/20/2007
Last Update Date : 10/19/2007

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Directions to “GENTLE DENTAL PLYMOUTH ROAD PLLC ” Practice Location

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