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NPI Code Detail

MEDICARE: CANTON CENTER DENTAL PLLC

MEDICARE: CANTON CENTER DENTAL 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
1122300000XDentist2901017652MI
2122300000XDentist2901020144MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11811954415OTHERMINPPES
219526324547OTHERMINNPES

General Provider Information

NPI Number : 1598187668
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTON CENTER DENTAL PLLC
Provider Business Mailing Address
First Line : 401 N. CANTON CENTER ROAD SUITE #3
Second Line :
City : CANTON
State : MI
Zip : 48187-5096
Country : US
Telephone Number : 734-217-4370
Fax Number :
Provider Business Practice Location Address
First Line : 401 N. CANTON CTR. RD. STE. #3
Second Line :
City : CANTON
State : MI
Zip : 48187-5096
Country : US
Telephone Number : 734-217-4370
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. STEVEN LAWRENCE FLETCHER
Credential : DDS
Telephone Number : 734-217-4370
Provider Enumeration Date : 01/09/2014
Last Update Date : 01/09/2014

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Directions to “CANTON CENTER DENTAL PLLC ” Practice Location

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