Crescent Lake Dental Care PLLC
Clinic/Center, Dental in Waterford, MI. Organization (NPI-2).
NPI number1124884366
StatusActive
Last updated in NPPESFeb 26, 2024
Details
- NPI
- 1124884366
- Entity type
- Organization (NPI-2)
- Legal business name
- Crescent Lake Dental Care PLLC
- Organization subpart
- No
- Enumeration date
- Feb 26, 2024
- Certification date
- Feb 26, 2024
- Last updated
- Feb 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
998 Crescent Lake RdWaterford, MI 48327-2594
Phone 248-682-9331
Mailing address
1849 N Denwood StDearborn, MI 48128-1156
Authorized official
Mohammed Sobh
Owner/Doctor
3136636484
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