| Supreme Dental Of Plymouth Road Pc | |
|
20720 Plymouth Rd Detroit MI 48228-1275 | |
| (313) 342-1997 | |
| Not Available |
| Full Name | Supreme Dental Of Plymouth Road Pc |
|---|---|
| Speciality | Dentist |
| Location | 20720 Plymouth Rd, Detroit, Michigan |
| Authorized Official Name and Position | Michele Bloxson (PRESIDENT) |
| Authorized Official Contact | 3134166806 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Dental Of Plymouth Road Pc 27201 Ryan Rd Warren MI 48092-5127 Ph: () - | Supreme Dental Of Plymouth Road Pc 20720 Plymouth Rd Detroit MI 48228-1275 Ph: (313) 342-1997 |
| NPI Number | 1649693102 |
|---|---|
| Provider Enumeration Date | 02/03/2014 |
| Last Update Date | 02/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649693102 | NPI | - | NPPES |
| 1003804303 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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