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WATERFORD KIDS DENTAL CLUB PLLC NPI 1689224818


NPI Information

NPI: 1689224818
Provider Name: WATERFORD KIDS DENTAL CLUB, PLLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 23D0372415

Address:
3801 ELIZABETH LAKE RD
WATERFORD, MI
ZIP 48328
Phone: (248) 909-2132
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WATERFORD KIDS DENTAL CLUB, PLLC is a general practice dentist in Waterford, MI. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. WATERFORD KIDS DENTAL CLUB, PLLC NPI is 1689224818. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3801 ELIZABETH LAKE RD
WATERFORD, MI
ZIP 48328-017
Phone: (248) 909-2132

The provider's authorized official is Rebeca Urquiola .
The authorized official title is Owner and has the following contact phone number (248) 909-2132.

The CLIA number assigned to this NPI record is 23D0372415 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/19/2019 and was last updated on 9/19/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.