Organization
PERIODONTAL SPECIALISTS OF CLARKSTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUHEIL MICHAEL BOUTROS DDS,MS (CEO/PRESIDENT)
(810) 695-6444
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
16909
MI
Other
Enumeration date
01/22/2008
Last updated
04/25/2022
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