| Michigan Periodontics Group Llc | |
|
350 N Main St Ste 110 Chelsea MI 48118-1486 | |
| (734) 719-2700 | |
| Not Available |
| Full Name | Michigan Periodontics Group Llc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 350 N Main St Ste 110, Chelsea, Michigan |
| Authorized Official Name and Position | Shawn Michael Etherton (REGIONAL MANAGER) |
| Authorized Official Contact | 6167806879 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Periodontics Group Llc 350 North Main Street Suite 110 Chelsea MI 48118 Ph: (734) 719-2700 | Michigan Periodontics Group Llc 350 N Main St Ste 110 Chelsea MI 48118-1486 Ph: (734) 719-2700 |
| NPI Number | 1578002812 |
|---|---|
| Provider Enumeration Date | 02/20/2017 |
| Last Update Date | 02/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578002812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 2901021083 (Michigan) | Primary |
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