| Diversified Dental, P.c. | |
|
30231 Jefferson Ave Saint Clair Shores MI 48082-1787 | |
| (586) 775-2400 | |
| Not Available |
| Full Name | Diversified Dental, P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 30231 Jefferson Ave, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Kevin D Prush (DENTIST) |
| Authorized Official Contact | 5867752400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diversified Dental, P.c. 30231 Jefferson Ave Saint Clair Shores MI 48082-1787 Ph: () - | Diversified Dental, P.c. 30231 Jefferson Ave Saint Clair Shores MI 48082-1787 Ph: (586) 775-2400 |
| NPI Number | 1669191342 |
|---|---|
| Provider Enumeration Date | 08/25/2022 |
| Last Update Date | 08/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669191342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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