| Eagan Family Dentistry | |
|
17600 W 12 Mile Road Suite 4 Southfield MI 48076-1910 | |
| (248) 569-8770 | |
| (248) 569-2476 |
| Full Name | Eagan Family Dentistry |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 17600 W 12 Mile Road, Southfield, Michigan |
| Authorized Official Name and Position | Joy Victor Eagan (OWNER) |
| Authorized Official Contact | 2485698770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagan Family Dentistry 17600 W 12 Mile Road Suite 4 Southfield MI 48076-1910 Ph: (248) 569-8770 | Eagan Family Dentistry 17600 W 12 Mile Road Suite 4 Southfield MI 48076-1910 Ph: (248) 569-8770 |
| NPI Number | 1194861765 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194861765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 13440 (Michigan) | Primary |
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