| Organization Name: | CENTERLINE DENTURE CLINIC |
| NPI Number: | 1497900302 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RENEE K ELLIOTT (OFFICE MANAGER) |
| Mailing Address: | 24625 Van Dyke Ave Center Line |
| State: | MI US |
| Postal Code: | 480152303 |
| Phone Number: | 5867565880 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2008 |
| NPI Last Update Date: | 11/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 4963 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |