NPI: 1205815628 · ROYAL OAK, MI 48067 · General Practice Dentistry · NPI assigned 01/13/2006
| Authorized Official | COSTELLO, DANIEL (MANAGER) |
| NPI Enumeration Date | 01/13/2006 |
Other providers sharing the same authorized official: COSTELLO, DANIEL
| Provider | City | State | Total Paid |
|---|---|---|---|
| ROYAL OAK FAMILY DENTISTRY PC | ROYAL OAK | MI | $300.00 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 27 | $756.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 27 | 27 | $756.00 |