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Organization

WILLOW CREEK DENTAL CLINIC, PC

Active
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Organization

WILLOW CREEK DENTAL CLINIC, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JACK FALVO DDS (PRESIDENT)
(734) 981-5455
Entity
Organization

Contact information

Practice address
5970 N LILLEY RD, CANTON, MI 48187-3625
(734) 981-5455
(734) 981-0370
Mailing address
5970 N LILLEY RD, CANTON, MI 48187-3625
(734) 981-5455
(734) 981-0370

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11038
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4044756
—
MI
05
—
4045655
—
MI
05
—
4648480
—
MI
05
—
4784419
—
MI
05
—
4876118
—
MI
01
—
972811
UCCI
MI
01
—
D8014557
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/11/2006
Last updated
08/22/2020
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