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NPI Code Detail

MEDICARE: SQUARE LAKE FAMILY DENTISTRY

MEDICARE: SQUARE LAKE FAMILY DENTISTRY
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
11223G0001XGeneral Practice Dentistry2901015929MI
21223G0001XGeneral Practice Dentistry2901015961MI

General Provider Information

NPI Number : 1558442202
Entity Type Code : Organization
Provider Name (Legal Business Name) : SQUARE LAKE FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 6053 ROCHESTER RD
Second Line :
City : TROY
State : MI
Zip : 48085-1303
Country : US
Telephone Number : 248-879-5858
Fax Number : 248-879-3578
Provider Business Practice Location Address
First Line : 6053 ROCHESTER RD
Second Line :
City : TROY
State : MI
Zip : 48085-1303
Country : US
Telephone Number : 248-879-5858
Fax Number : 248-879-3578
Authorized Official
Title or Position : SECRETARY
Name : DR. PRITIDA TUSHAR PATEL
Credential : DDS
Telephone Number : 248-879-5858
Provider Enumeration Date : 10/18/2006
Last Update Date : 01/31/2008

Similar Medicare Providers

1750235222 — HANNADMD.PLLC
Practice Location Address:
6053 ROCHESTER RD
TROY, MI
48085-1303
Practice Phone: 248-879-5858
Practice Fax:
1508022419 — PRITIDA T PATEL DDS
Practice Location Address:
6053 ROCHESTER RD
TROY, MI
48085-1303
Practice Phone: 248-879-5858
Practice Fax:
1104082916 — DR. MANISHA VRAJESH PATEL D.D.S.
Practice Location Address:
6053 ROCHESTER RD
TROY, MI
48085-1303
Practice Phone: 248-879-5858
Practice Fax:
1245036953 — NEW TROY GROUP DENTAL PLLC
Practice Location Address:
6053 ROCHESTER RD
TROY, MI
48085-1303
Practice Phone: 248-558-2785
Practice Fax:
1679447858 — TROY GROUP DENTAL ASSOCIATES PLLC
Practice Location Address:
6053 ROCHESTER RD
TROY, MI
48085-1303
Practice Phone: 248-749-5858
Practice Fax:
1790816148 — MR. THOMAS JOSEPH DILWORTH
Practice Location Address:
3 SECOND STREET
TROY, OH
45373-1303
Practice Phone: 937-602-1929
Practice Fax:

Directions to “SQUARE LAKE FAMILY DENTISTRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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