# PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN,LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Refresh Dental Warren - E. 12 Mile Rd
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164771481
- **Authorized official:** SHAMS HAMAMA (REGIONAL MANAGER)
- **Authorized official phone:** (586) 573-7500

## Contact information

- **Practice address:** 11552 E 12 MILE RD, WARREN, MI 48093-2644
- **Practice address phone:** (586) 573-7500
- **Mailing address:** 11 S MILL ST, STE 200, NEW CASTLE, PA 16101-3613
- **Mailing address phone:** (724) 698-2500

## Taxonomy

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

## Other

- **Enumeration date:** 08/31/2012
- **Last updated:** 04/19/2018