NPI: 1477792620 · ROYAL OAK, MI 48067 · General Practice Dentistry · NPI assigned 02/11/2009
| Authorized Official | COSTELLO, DANIEL (MANAGER) |
| NPI Enumeration Date | 02/11/2009 |
Other providers sharing the same authorized official: COSTELLO, DANIEL
| Provider | City | State | Total Paid |
|---|---|---|---|
| ROYAL OAK FAMILY DENTISTRY | ROYAL OAK | MI | $756.00 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 12 | $300.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 12 | 12 | $300.00 |