| Eastside Periodontal Assoc Pllc | |
|
25523 Van Dyke Ave Center Line MI 48015-1824 | |
| (586) 757-5454 | |
| (586) 757-4147 |
| Full Name | Eastside Periodontal Assoc Pllc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 25523 Van Dyke Ave, Center Line, Michigan |
| Authorized Official Name and Position | Jennifer Lynn Wise (OFFICE MANAGER) |
| Authorized Official Contact | 5867575454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Periodontal Assoc Pllc 25523 Van Dyke Ave Center Line MI 48015-1824 Ph: (586) 757-5454 | Eastside Periodontal Assoc Pllc 25523 Van Dyke Ave Center Line MI 48015-1824 Ph: (586) 757-5454 |
| NPI Number | 1144312760 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144312760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | B18275 (Michigan) | Primary |
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