Organization
NORTHEAST DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA GRACE (OFFICE MANAGER)
(248) 552-0166
Entity
Organization
Contact information
Practice address
21500 NORTHWESTERN HWY, SUITE 640, SOUTHFIELD, MI 48075-5018
(248) 552-0166
Mailing address
21500 NORTHWESTERN HWY, SUITE 640, SOUTHFIELD, MI 48075-5018
(248) 552-0166
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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