# DISTINCTIVE DENTAL

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

## Provider details

- **NPI number:** 1295902302
- **Authorized official:** DR. THOMAS MICHAEL DAVIDSON DDS (DENTIST)
- **Authorized official phone:** (586) 207-6013

## Contact information

- **Practice address:** 58047 VAN DYKE RD, SUITE \#101, WASHINGTON TWP, MI 48094-4000
- **Practice address phone:** (586) 207-6013
- **Practice address fax:** (586) 207-6300
- **Mailing address:** 58047 VAN DYKE RD, SUITE \#101, WASHINGTON TWP, MI 48094-4000
- **Mailing address phone:** (586) 207-6013
- **Mailing address fax:** (586) 207-6300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 1223G0001X | General Practice Dentistry | — | NULL | — |

## Other

- **Enumeration date:** 05/08/2008
- **Last updated:** 04/07/2025