MEDICARE: WEST BLOOMFIELD DENTISTRY, 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679302764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST BLOOMFIELD DENTISTRY, PLLC

Provider Business Mailing Address
First Line	:	2040 WOODROW WILSON DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324
Country	:	US
Telephone Number	:	248-682-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 WOODROW WILSON BLVD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-1772
Country	:	US
Telephone Number	:	248-682-2550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHIRLEY NAKASH
Credential	:	D.D.S.
Telephone Number	:	248-682-2550

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	08/08/2024

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