Organization

Odicare Pc

Dentist in Detroit, MI(View on Map)

Legal Business Name

Odicare Pc

NPI Number

1497180798

NPI Type

Organization

Enumeration Date

09/06/2013

Specialties

(Taxonomies)

Name

Code

122300000X

Primary Taxonomy

Yes

Licenses

State

Michigan

License Number

2901011444

Contact
Information

Purpose

Mailing
Location

Address

27201 RYAN RD
15510 LIVERNOIS AVE

City

Warren
Detroit

State

MI
MI

Postal Code

48092-5127
48238-1343

Country

US
US

Telephone Number

(586) 558-8004
(313) 863-3800

Authorized Official

Name

Dr. Jerel Owens

Title or Position

RESPONSIBLE PARTY

Telephone Number

(313) 341-3684

Identifiers

Identifier

4718431

Identifier State

MI

Identifier Issuer

Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/06/2013

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