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Organization
EASTSIDE IMPLANTS AND PERIODONTICS
Active
Organization
EASTSIDE IMPLANTS AND PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MISCH D.D.S., M.S. (OWNER/PERIODONTIST)
(734) 975-1743
Entity
Organization
Contact information
Practice address
25523 VAN DYKE AVENUE, CENTER LINE, MI 48015
(586) 757-5454
(586) 757-4147
Mailing address
25523 VAN DYKE AVENUE, CENTER LINE, MI 48015
(734) 975-1743
(734) 975-1754
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
07/11/2024
Last updated
07/11/2024
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