MEDICARE: NYE DENTAL OF CLINTON 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1376294975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYE DENTAL OF CLINTON PLLC

Provider Business Mailing Address
First Line	:	41840 HAYES RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1876
Country	:	US
Telephone Number	:	215-821-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	41840 HAYES RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1876
Country	:	US
Telephone Number	:	215-821-5073
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SAMER ANBAKI
Credential	:
Telephone Number	:	734-374-2070

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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