# PRIME DENTISTRY LINCOLN PARK

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

## Provider details

- **NPI number:** 1164128401
- **Authorized official:** JESSICA TOMES (OPERATIONS DIRECTOR)
- **Authorized official phone:** (734) 722-1617

## Contact information

- **Practice address:** 1880 EMMONS BLVD, LINCOLN PARK, MI 48146-3866
- **Practice address phone:** (313) 388-8444
- **Mailing address:** 24505 FAIRMOUNT DR, DEARBORN, MI 48124-1541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/07/2023
- **Last updated:** 02/07/2023