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Organization
MEADOWBROOK FAMILY DENTISTS PC
Active
Organization
MEADOWBROOK FAMILY DENTISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY J CLAGUE DDS (PRESIDENT)
(248) 528-1611
Entity
Organization
Contact information
Practice address
5127 ROCHESTER RD, TROY, MI 48085
(248) 528-1611
(248) 528-0245
Mailing address
5127 ROCHESTER RD, TROY, MI 48085
(248) 528-1611
(248) 528-0245
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D800187
BCBS MI
MI
Enumeration date
11/07/2006
Last updated
08/22/2020
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