Organization
MONUMENT DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA MARIE KIRCHNER (INSURANCE MANAGER)
(586) 915-0107
Entity
Organization
Contact information
Practice address
15510 LIVERNOIS AVENUE, DETROIT, MI 48238
(313) 863-2800
(313) 341-7867
Mailing address
15510 LIVERNOIS AVENUE, DETROIT, MI 48238
(313) 863-2800
(313) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901021011
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901021011
STATE LICENSE
MI
Enumeration date
10/29/2014
Last updated
05/12/2015
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