Organization
DIVERSIFIED DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN D PRUSH DDS (DENTIST)
(586) 775-2400
Entity
Organization
Contact information
Practice address
30231 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48082-1787
(586) 775-2400
Mailing address
30231 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48082-1787
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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