Southfield Dental Pllc | |
17600 W 12 Mile Rd Suite 3 Southfield MI 48076-1910 | |
(248) 569-6722 | |
(248) 569-7409 |
Full Name | Southfield Dental Pllc |
---|---|
Speciality | Dentist |
Location | 17600 W 12 Mile Rd, Southfield, Michigan |
Authorized Official Name and Position | Raymond A Fortson (MEMBER) |
Authorized Official Contact | 2485696722 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Southfield Dental Pllc 17600 W 12 Mile Rd Suite 3 Southfield MI 48076-1910 Ph: (248) 569-6722 | Southfield Dental Pllc 17600 W 12 Mile Rd Suite 3 Southfield MI 48076-1910 Ph: (248) 569-6722 |
NPI Number | 1104067644 |
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Provider Enumeration Date | 03/12/2009 |
Last Update Date | 03/12/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104067644 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 2901014077 (Michigan) | Primary |
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