Organization
PERIODONTAL SPECIALISTS OF CLARKSTON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM STRADER (INSURANCE COORDINATOR)
(248) 625-1721
Entity
Organization
Contact information
Practice address
6803 DIXIE HWY STE 1, CLARKSTON, MI 48346-5101
(248) 625-1721
(248) 625-5475
Mailing address
6803 DIXIE HWY STE 1, CLARKSTON, MI 48346-5101
(248) 625-1721
(248) 625-5475
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548447576
FEE FOR SERVICE
MI
Enumeration date
05/09/2022
Last updated
05/09/2022
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