# WEST BLOMMFIELD DENTAL AND ASSOCIATES PLLC

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

## Provider details

- **NPI number:** 1629371182
- **Authorized official:** GLEN BRIAN DAVIS (CEO)
- **Authorized official phone:** (248) 851-5650

## Contact information

- **Practice address:** 6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
- **Practice address phone:** (248) 851-5650
- **Practice address fax:** (248) 851-5663
- **Mailing address:** 6900 ORCHARD LAKE RD, 211, WEST BLOOMFIELD, MI 48322-3405
- **Mailing address phone:** (248) 851-5650
- **Mailing address fax:** (248) 851-5663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 017174 | MI | Yes |
| 124Q00000X | Dental Hygienist | 2902011884 | MI | — |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 12/06/2010
- **Last updated:** 12/06/2010