Organization
PROSTHODONTIC & IMPLANT CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN P. WEINS DDS, MSD (OWNER)
(248) 855-6655
Entity
Organization
Contact information
Practice address
6177 ORCHARD LAKE ROAD, SUITE #120, WEST BLOOMFIELD, MI 48322
(248) 855-6655
(248) 855-0803
Mailing address
6177 ORCHARD LAKE ROAD, SUITE #120, WEST BLOOMFIELD, MI 48322
(248) 855-6655
(248) 855-0803
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2901010565
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901010587
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2758821
—
MI
05
—
3239144
—
MI
Enumeration date
08/09/2007
Last updated
05/12/2017
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