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NPI Code Detail

MEDICARE: MONOSETA C. BURWELL, D.M.D., P.C.

MEDICARE: MONOSETA C. BURWELL, D.M.D., P.C.
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
1261QD0000XDental Clinic/Center2901013087MI

General Provider Information

NPI Number : 1760935993
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONOSETA C. BURWELL, D.M.D., P.C.
Provider Business Mailing Address
First Line : 18951 W 12 MILE RD
Second Line :
City : LATHRUP VILLAGE
State : MI
Zip : 48076-2575
Country : US
Telephone Number : 248-353-4747
Fax Number : 248-353-2297
Provider Business Practice Location Address
First Line : 18951 W 12 MILE RD
Second Line :
City : LATHRUP VILLAGE
State : MI
Zip : 48076-2575
Country : US
Telephone Number : 248-353-4747
Fax Number : 248-353-2297
Authorized Official
Title or Position : PRESIDENT/DENTIST
Name : DR. MONOSETA COVINGTON-BURWELL
Credential : D.M.D.
Telephone Number : 248-353-4747
Provider Enumeration Date : 07/23/2016
Last Update Date : 07/23/2016

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