Provider Demographics
NPI:1003985169
Name:PDC MANAGEMEN
Entity Type:Organization
Organization Name:PDC MANAGEMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-842-8300
Mailing Address - Street 1:5831 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2159
Mailing Address - Country:US
Mailing Address - Phone:313-842-8300
Mailing Address - Fax:313-842-8530
Practice Address - Street 1:5831 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2159
Practice Address - Country:US
Practice Address - Phone:313-842-8300
Practice Address - Fax:313-842-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty