Organization
DISTRICT DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAVIS D PHILLIPS (OFFICE MANAGER)
(313) 535-5200
Entity
Organization
Contact information
Practice address
15064 HOUSTON WHITTIER ST, DETROIT, MI 48205-4127
(313) 535-5200
(313) 535-0011
Mailing address
15064 HOUSTON WHITTIER ST, DETROIT, MI 48205-4127
(313) 535-5200
(313) 535-0011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901014040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1908675
—
MI
Enumeration date
10/20/2009
Last updated
10/20/2009
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