Organization · NPI-2

42 North Dental Care Of Michigan, PLLC

Clinic/Center, Dental · Livonia, MI

NPI number1871233775

StatusActive

Last updated in NPPESMar 30, 2022

Details

NPI: 1871233775
Entity type: Organization (NPI-2)
Legal business name: 42 North Dental Care Of Michigan, PLLC
Organization subpart: Yes
Enumeration date: Mar 30, 2022
Certification date: Mar 30, 2022
Last updated: Mar 30, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QD0000X	Clinic/Center, Dental	–	–	Yes

Other names

Great Lakes Family Dental, Livonia (Doing Business As)

Practice location

16160 Middlebelt Rd
Livonia, MI 48154-3338

Phone 734-261-9696

Mailing address

16160 Middlebelt Rd
Livonia, MI 48154-3338

Authorized official

Michael Angelo Scialabba
Chief Clinical Officer
5615122709

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