# REDWOOD DENTAL GROUP

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

## Provider details

- **NPI number:** 1164893392
- **Authorized official:** DR. MARK A BOUCHILLON D.D.S. (PRESIDENT)
- **Authorized official phone:** 15869792800

## Contact information

- **Practice address:** 6511 N CANTON CENTER RD, CANTON, MI 48187-1653
- **Practice address phone:** (248) 577-5188
- **Mailing address:** 255 W 13 MILE RD, SUITE \#100, MADISON HEIGHTS, MI 48071-1868
- **Mailing address phone:** (734) 722-5130
- **Mailing address fax:** (734) 722-5192

## Taxonomy

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

## Other

- **Enumeration date:** 10/14/2015
- **Last updated:** 10/14/2015