MEDICARE: PHILIP DUELL DDS PC

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	2901014599	MI

General Provider Information

NPI Number	:	1689884371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP DUELL DDS PC

Provider Business Mailing Address
First Line	:	22341 WEST RD
Second Line	:
City	:	WOODHAVEN
State	:	MI
Zip	:	48183-3157
Country	:	US
Telephone Number	:	734-671-1620
Fax Number	:	734-671-2154

Provider Business Practice Location Address
First Line	:	22341 WEST RD
Second Line	:
City	:	WOODHAVEN
State	:	MI
Zip	:	48183-3157
Country	:	US
Telephone Number	:	734-671-1620
Fax Number	:	734-671-2154

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP DUELL
Credential	:	D.D.S.
Telephone Number	:	734-671-1620

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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