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Organization
MODERN AMERICAN DENTAL CLINIC PC
Active
Organization
MODERN AMERICAN DENTAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NABIL BERRY DENTIST DDS (DENTIST OWNER)
(313) 582-1919
Entity
Organization
Contact information
Practice address
14350 W WARREN, DEARBORN, MI 48126
(313) 582-1919
(313) 582-0300
Mailing address
14350 W WARREN, DEARBORN, MI 48126
(313) 582-1919
(313) 582-0300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4773148
—
MI
01
—
D15159MI
LICENSE
MI
Enumeration date
10/11/2006
Last updated
01/29/2016
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