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NPI Code Detail

MEDICARE: DR. JAMES MICHAEL SOCKOLOSKY D.D.S.

MEDICARE: DR. JAMES MICHAEL SOCKOLOSKY 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
11223G0001XGeneral Practice Dentistry9793MI

General Provider Information

NPI Number : 1891790929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES MICHAEL SOCKOLOSKY D.D.S.
Provider Business Mailing Address
First Line : 45139 BROOKSIDE CT
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-3846
Country : US
Telephone Number : 734-459-4085
Fax Number :
Provider Business Practice Location Address
First Line : 35000 FORD RD
Second Line : STE 6
City : WESTLAND
State : MI
Zip : 48185-3719
Country : US
Telephone Number : 734-326-2030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/08/2007

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