Organization
ENDODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA SHANK (BOOK KEEPER)
(313) 565-9118
Entity
Organization
Contact information
Practice address
22731 NEWMAN ST STE 125, DEARBORN, MI 48124
(313) 565-9118
(313) 565-2672
Mailing address
22731 NEWMAN ST STE 125, DEARBORN, MI 48124
(313) 565-9118
(313) 565-2672
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
10546
MI
1223E0200X
Endodontics
13637
MI
1223E0200X
Endodontics
14484
MI
1223E0200X
Endodontics
16152
MI
1223E0200X
Endodontics
17362
MI
1223E0200X
Endodontics
18227
MI
1223E0200X
Endodontics
Primary
8357
MI
1223E0200X
Endodontics
9366
MI
1223E0200X
Endodontics
9563
MI
Other
Enumeration date
04/27/2006
Last updated
08/07/2020
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