Michigan Dental Pc | |
4626 W Walton Blvd Waterford MI 48329-3535 | |
(248) 674-0384 | |
(248) 674-1483 |
Full Name | Michigan Dental Pc |
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Speciality | Dentist |
Location | 4626 W Walton Blvd, Waterford, Michigan |
Authorized Official Name and Position | Amanda Marie Sheehan (OWNER) |
Authorized Official Contact | 2486740384 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Michigan Dental Pc 4626 W Walton Blvd Waterford MI 48329-3535 Ph: (248) 674-0384 | Michigan Dental Pc 4626 W Walton Blvd Waterford MI 48329-3535 Ph: (248) 674-0384 |
NPI Number | 1215402383 |
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Provider Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |
Medicare PECOS PAC ID | 8729412085 |
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Medicare Enrollment ID | O20191220000375 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215402383 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Provider Name | Amanda Marie Sheehan |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1386938561 PECOS PAC ID: 8921329533 Enrollment ID: I20191220000432 |
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