Organization
MODERN AMERICAN DENTAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NABIL BERRY DENTIST DDS (DENTIST OWNER)
(313) 582-1919
Entity
Organization
Contact information
Practice address
14350 W WARREN, DEARBORN, MI 48126
(313) 582-1919
(313) 582-0300
Mailing address
14350 W WARREN, DEARBORN, MI 48126
(313) 582-1919
(313) 582-0300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4773148
—
MI
01
—
D15159MI
LICENSE
MI
Enumeration date
10/11/2006
Last updated
01/29/2016
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