# MICHIGAN PRIVATE DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Stoneridge Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902203227
- **Authorized official:** DR. ANTHONY R BIELKIE DDS (PRESIDENT)
- **Authorized official phone:** (586) 771-3440

## Contact information

- **Practice address:** 27731 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48081-1309
- **Practice address phone:** (586) 771-6440
- **Practice address fax:** (586) 771-8877
- **Mailing address:** 27731 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48081-1309
- **Mailing address phone:** (586) 771-6440
- **Mailing address fax:** (586) 771-8877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 15810 | MI | Yes |
| 1223G0001X | General Practice Dentistry | 19241 | MI | — |

## Other

- **Enumeration date:** 12/02/2014
- **Last updated:** 12/02/2014