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NPI Code Detail

MEDICARE: CLIO FAMILY DENTISTRY PLC

MEDICARE: CLIO FAMILY DENTISTRY 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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1366050619
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLIO FAMILY DENTISTRY PLC
Provider Business Mailing Address
First Line : 4279 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-9440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4279 W VIENNA RD
Second Line :
City : CLIO
State : MI
Zip : 48420-9440
Country : US
Telephone Number : 810-687-2000
Fax Number :
Authorized Official
Title or Position : GENERAL DENTIST
Name : DR. CHAD MARK WITKOW
Credential : DDS
Telephone Number : 810-687-2000
Provider Enumeration Date : 07/22/2020
Last Update Date : 07/22/2020

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Practice Location Address:
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Directions to “CLIO FAMILY DENTISTRY PLC ” Practice Location

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