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Organization
SQUARE LAKE FAMILY DENTISTRY
Active
Organization
SQUARE LAKE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRITIDA TUSHAR PATEL DDS (SECRETARY)
(248) 879-5858
Entity
Organization
Contact information
Practice address
6053 ROCHESTER RD, TROY, MI 48085-1303
(248) 879-5858
(248) 879-3578
Mailing address
6053 ROCHESTER RD, TROY, MI 48085-1303
(248) 879-5858
(248) 879-3578
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901015929
MI
1223G0001X
General Practice Dentistry
Primary
2901015961
MI
Other
Enumeration date
10/18/2006
Last updated
01/31/2008
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