MEDICARE: THUMBS UP DENTAL 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
1	1223G0001X	General Practice Dentistry	14179	MI

General Provider Information

NPI Number	:	1396194593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THUMBS UP DENTAL PLC

Provider Business Mailing Address
First Line	:	4450 W WALTON BLVD
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-4093
Country	:	US
Telephone Number	:	248-674-0495
Fax Number	:	248-674-4308

Provider Business Practice Location Address
First Line	:	6668 BERNIE KOHLER DR
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8885
Country	:	US
Telephone Number	:	810-688-3047
Fax Number	:	810-688-3109

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELISSA SCHROEDER
Credential	:
Telephone Number	:	248-674-0495

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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