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28225 Hoover Rd Warren MI 48093-5436 | |
| (586) 751-6868 | |
| (586) 751-6264 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 28225 Hoover Rd, Warren, Michigan |
| Authorized Official Name and Position | Mark A Kohn (OWNER PRESIDENT) |
| Authorized Official Contact | 5867516868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
28225 Hoover Rd Warren MI 48093-5436 Ph: (586) 751-6868 | 28225 Hoover Rd Warren MI 48093-5436 Ph: (586) 751-6868 |
| NPI Number | 1386667582 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4385645613 |
|---|---|
| Medicare Enrollment ID | O20070129000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386667582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 15192 (Michigan) | Primary |
| Provider Name | Mark A Kohn |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1689645988 PECOS PAC ID: 0941201271 Enrollment ID: I20070129000626 |
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