MEDICARE: DR. TERESA A. GORSKI D.D.S.

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	II048	MI

General Provider Information

NPI Number	:	1881819241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA A. GORSKI D.D.S.

Provider Business Mailing Address
First Line	:	1668 LEXINGTON DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-5707
Country	:	US
Telephone Number	:	248-816-9901
Fax Number	:	248-269-6990

Provider Business Practice Location Address
First Line	:	7433 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-2227
Country	:	US
Telephone Number	:	313-842-4255
Fax Number	:	313-842-1211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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