| Fort Street Dentistry | |
|
4009 Fort St Lincoln Park MI 48146-4110 | |
| (313) 928-8555 | |
| (313) 928-1399 |
| Full Name | Fort Street Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 4009 Fort St, Lincoln Park, Michigan |
| Authorized Official Name and Position | Shawn M Lavoie (INSURANCE BILLER) |
| Authorized Official Contact | 31392885555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Street Dentistry 4009 Fort St Lincoln Park MI 48146-4110 Ph: (313) 928-8555 | Fort Street Dentistry 4009 Fort St Lincoln Park MI 48146-4110 Ph: (313) 928-8555 |
| NPI Number | 1194081273 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/03/2012 |
| Medicare PECOS PAC ID | 0042511297 |
|---|---|
| Medicare Enrollment ID | O20151214001135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194081273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901016290 (Michigan) | Primary |
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