MEDICARE: MCADOO DENTAL

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	08693	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417014770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCADOO DENTAL

Provider Business Mailing Address
First Line	:	18424 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4161
Country	:	US
Telephone Number	:	313-537-3800
Fax Number	:	313-537-2080

Provider Business Practice Location Address
First Line	:	18424 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4161
Country	:	US
Telephone Number	:	313-537-3800
Fax Number	:	313-537-2080

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERALD MCADOO
Credential	:	D.D.S.
Telephone Number	:	313-537-3800

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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Directions to “MCADOO DENTAL ” Practice Location

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