| Mike Kostakos, Dds, P.c. | |
|
20307 W 12 Mile Rd Ste 101 Southfield MI 48076-5407 | |
| (248) 559-1220 | |
| (248) 559-4300 |
| Full Name | Mike Kostakos, Dds, P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 20307 W 12 Mile Rd Ste 101, Southfield, Michigan |
| Authorized Official Name and Position | Wala Salama (OFFICE MANAGER) |
| Authorized Official Contact | 2485591220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mike Kostakos, Dds, P.c. 20307 W 12 Mile Rd Ste 101 Southfield MI 48076-5407 Ph: (248) 559-1220 | Mike Kostakos, Dds, P.c. 20307 W 12 Mile Rd Ste 101 Southfield MI 48076-5407 Ph: (248) 559-1220 |
| NPI Number | 1295441822 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 01/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295441822 | NPI | - | NPPES |
| 1700932241 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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