Organization
PREVENTATIVE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA L HYDE (OFFICE MANAGER)
(313) 863-2800
Entity
Organization
Contact information
Practice address
15510 LIVERNOIS AVE, DETROIT, MI 48238-1343
(313) 863-2800
Mailing address
PO BOX 38367, DETROIT, MI 48238-0367
(313) 863-2800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MI
Other
Enumeration date
06/24/2013
Last updated
06/24/2013
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