NPI: 1497343685 · WALLED LAKE, MI 48390 · General Practice Dentistry · NPI assigned 01/04/2021
| Authorized Official | VARDAN, OXANA (CREDENTIALING SPECIALIST) |
| NPI Enumeration Date | 01/04/2021 |
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 13 | $762.31 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 13 | 13 | $762.31 |