# EASTLAND DENTAL CENTER

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

## Provider details

- **NPI number:** 1790845964
- **Authorized official:** GIANFRANCO TIBERIA DDS (OWNER)
- **Authorized official phone:** (313) 521-2070

## Contact information

- **Practice address:** 18000 VERNIER, HARPER WOODS, MI 48225
- **Practice address phone:** (313) 521-2070
- **Practice address fax:** (313) 526-9907
- **Mailing address:** 18000 VERNIER, HARPER WOODS, MI 48225
- **Mailing address phone:** (313) 521-2070
- **Mailing address fax:** (313) 526-9907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 17767 | MI | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4274738 | — | MI |