MEDICARE: MOSAIC DENTAL WELLNESS 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	:	1376472076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC DENTAL WELLNESS PLLC

Provider Business Mailing Address
First Line	:	650 E BIG BEAVER RD STE D
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-528-2270
Fax Number	:	248-528-2377

Provider Business Practice Location Address
First Line	:	650 E BIG BEAVER RD STE D
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1432
Country	:	US
Telephone Number	:	248-528-2270
Fax Number	:	248-528-2377

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEB THOMASON
Credential	:
Telephone Number	:	248-528-2270

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/20/2026

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