MEDICARE: ROYAL DENTAL CENTER PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1982363677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL DENTAL CENTER PLLC

Provider Business Mailing Address
First Line	:	4819 HAGGERTY RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3901
Country	:	US
Telephone Number	:	248-863-9109
Fax Number	:	248-863-9122

Provider Business Practice Location Address
First Line	:	4819 HAGGERTY RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3901
Country	:	US
Telephone Number	:	248-863-9109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANAL ISMAIL
Credential	:
Telephone Number	:	313-828-9873

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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