MEDICARE: DR. MARK JOSEPH DOBRY D.D.S.

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	122300000X	Dentist	2901015912	MI

General Provider Information

NPI Number	:	1396818159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOSEPH DOBRY D.D.S.

Provider Business Mailing Address
First Line	:	3058 METROPOLITAN PKWY
Second Line	:	SUITE 106
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3671
Country	:	US
Telephone Number	:	586-979-0600
Fax Number	:	586-979-8209

Provider Business Practice Location Address
First Line	:	3058 METROPOLITAN PKWY
Second Line	:	SUITE 106
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3671
Country	:	US
Telephone Number	:	586-979-0600
Fax Number	:	586-979-8209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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