MEDICARE: GOLANI DENTAL CENTER

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	:	1962138032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLANI DENTAL CENTER

Provider Business Mailing Address
First Line	:	22720 WOODWARD AVE # 107
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22720 WOODWARD AVE # 107
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2920
Country	:	US
Telephone Number	:	258-548-1178
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAMIRAN GOLANI
Credential	:	DDS
Telephone Number	:	248-548-1178

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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