Organization
ROBERT BRUCE MACINTOSH D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT BRUCE MACINTOSH D.D.S. (PRESIDENT)
(248) 642-2115
Entity
Organization
Contact information
Practice address
31100 TELEGRAPH RD, SUITE 100, BINGHAM FARMS, MI 48025-4363
(248) 642-2115
(248) 642-6387
Mailing address
31100 TELEGRAPH RD, SUITE 100, BINGHAM FARMS, MI 48025-4363
(248) 642-2115
(248) 642-6387
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
007491
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2996322
—
MI
01
—
4007538
MEDICAID DENTAL
MI
Enumeration date
09/26/2006
Last updated
01/03/2008
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