Organization
ALL ABOUT ORTHODONTICS SOUTHGATE, PC
Active
Organization
ALL ABOUT ORTHODONTICS SOUTHGATE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA PUTRUS (OFFICE MANAGER)
(586) 834-8000
Entity
Organization
Contact information
Practice address
15401 DIX TOLEDO RD, SOUTHGATE, MI 48195-2662
(734) 999-4774
Mailing address
4600 E 14 MILE RD STE 3/4, WARREN, MI 48092-4369
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457899429
NPI
—
Enumeration date
01/31/2024
Last updated
01/31/2024
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