MEDICARE: DETROIT DENTAL CARE, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1790228476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DETROIT DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	14353 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-2557
Country	:	US
Telephone Number	:	313-863-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	14353 LIVERNOIS AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-2557
Country	:	US
Telephone Number	:	313-863-2800
Fax Number	:

Authorized Official
Title or Position	:	BILLING AND CREDENTIALING MANAGER
Name	:	SUSAN DUNFORD
Credential	:
Telephone Number	:	313-651-8041

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	01/18/2026

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