Individual
DR. MARIO ENDIAKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
13874 GRAND RIVER AVE, DETROIT, MI 48227-3123
(313) 834-4900
Mailing address
13874 GRAND RIVER AVE, DETROIT, MI 48227-3123
(313) 834-4900
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019031843
IL
122300000X
Dentist
Primary
2901602634
MI
390200000X
Student in an Organized Health Care Education/Training Program
2901602634
MI
Other
Enumeration date
06/05/2018
Last updated
09/02/2025
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