# SUPER DENTAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043460330
- **Authorized official:** DR. SANDRA A LOREDO DDS (DIRECTOR)
- **Authorized official phone:** (313) 863-2800

## Contact information

- **Practice address:** 15510 LIVERNOIS AVE, DETROIT, MI 48238-1343
- **Practice address phone:** (313) 863-2800
- **Mailing address:** PO BOX 38367, DETROIT, MI 48238
- **Mailing address phone:** (313) 863-2800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2008
- **Last updated:** 09/24/2008