- Practice location
- 21427 Grand River Ave Ste 100, Detroit, MI 48219-3897
- Phone
- 313-412-2100
- Fax
- 313-766-7734
- Last updated
- September 18, 2024
Pro Dental Mi 1 PC is a healthcare organization based in Detroit, MI. Pro Dental Mi 1 PC practices in Detroit, MI. The NPI Number for Pro Dental Mi 1 PC is 1457188955. The current practice location address for Pro Dental Mi 1 PC is 21427 Grand River Ave Ste 100, Detroit, MI 48219-3897 and can be reached out via phone at 313-412-2100 and via fax at 313-766-7734.
Provider Profile Details
- NPI Number
- 1457188955
- Provider Name
- Pro Dental Mi 1 PC
- Provider Entity Type
- Organization
- Address
- 21427 Grand River Ave Ste 100, Detroit, MI 48219-3897
- Phone Number
- 313-412-2100
- Fax Number
- 313-766-7734
- Primary Taxonomy
- Dentist · 122300000X
- Organization Subpart
- No
- Authorized Official
- Mrs. Simone Wilson-Adeleke, MPA-PPA · Director Of Credentialing · 732-914-3991
- Other Names
- Destiny Dental Of Grand River (Doing Business As)
- Provider Enumeration Date
- September 18, 2024
- Last Update Date
- September 18, 2024
- Certification Date
- September 18, 2024
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 21427 Grand River Ave Ste 100
Detroit, MI 48219-3897 - City
- Detroit
- State
- Michigan
- Zip
- 48219-3897
- Phone Number
- 313-412-2100
- Fax Number
- 313-766-7734
Provider Business Mailing Address Details
- Address
- 10 Woodbridge Center Dr Ste 520
Woodbridge, NJ 07095-1152 - City
- Woodbridge
- State
- NJ
- Zip
- 07095-1152
- Phone Number
- 732-914-1422
License Information
- Taxonomy (1)
- Dentist · 122300000X · Primary
- Taxonomy (2)
- Dentist, General Practice · 1223G0001X
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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- Dr. Quanza E Mooring, PHD, FNP-BCNurse Practitioner, Family · NPI 1770281016
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Frequently Asked Questions
What is the NPI number of Pro Dental Mi 1 PC?
The NPI number of Pro Dental Mi 1 PC is 1457188955. It was assigned on September 18, 2024 and is currently active in the NPPES registry.
What is the specialty of Pro Dental Mi 1 PC?
Pro Dental Mi 1 PC is registered under the primary taxonomy Dentist (code 122300000X).
Where does Pro Dental Mi 1 PC practice?
The practice location is 21427 Grand River Ave Ste 100, Detroit, MI 48219-3897. The office can be reached at 313-412-2100 (phone) or 313-766-7734 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1457188955 directly on the NPPES registry website.