| Odicare Pc | |
|
15510 Livernois Ave Detroit MI 48238-1343 | |
| (313) 863-3800 | |
| Not Available |
| Full Name | Odicare Pc |
|---|---|
| Speciality | Dentist |
| Location | 15510 Livernois Ave, Detroit, Michigan |
| Authorized Official Name and Position | Jerel N Owens (RESPONSIBLE PARTY) |
| Authorized Official Contact | 3133413684 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Odicare Pc 27201 Ryan Rd Warren MI 48092-5127 Ph: (586) 558-8004 | Odicare Pc 15510 Livernois Ave Detroit MI 48238-1343 Ph: (313) 863-3800 |
| NPI Number | 1497180798 |
|---|---|
| Provider Enumeration Date | 09/06/2013 |
| Last Update Date | 09/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497180798 | NPI | - | NPPES |
| 4718431 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901011444 (Michigan) | Primary |
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