| Pro Dental Mi 1 Pc | |
|
21427 Grand River Ave Ste 100 Detroit MI 48219-3897 | |
| (313) 412-2100 | |
| (313) 766-7734 |
| Full Name | Pro Dental Mi 1 Pc |
|---|---|
| Speciality | Dentist |
| Location | 21427 Grand River Ave Ste 100, Detroit, Michigan |
| Authorized Official Name and Position | Simone Wilson-adeleke (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 7329143991 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pro Dental Mi 1 Pc 10 Woodbridge Center Dr Ste 520 Woodbridge NJ 07095-1152 Ph: (732) 914-1422 | Pro Dental Mi 1 Pc 21427 Grand River Ave Ste 100 Detroit MI 48219-3897 Ph: (313) 412-2100 |
| NPI Number | 1457188955 |
|---|---|
| Provider Enumeration Date | 09/18/2024 |
| Last Update Date | 09/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457188955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
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