Provider Demographics
NPI:1306019609
Name:TOWER DENTAL CARE PLLC
Entity Type:Organization
Organization Name:TOWER DENTAL CARE PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-837-3000
Mailing Address - Street 1:15400 GRAND RIVER AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-4129
Mailing Address - Country:US
Mailing Address - Phone:313-837-3000
Mailing Address - Fax:313-838-4581
Practice Address - Street 1:15400 GRAND RIVER AVE STE 4
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-4129
Practice Address - Country:US
Practice Address - Phone:313-837-3000
Practice Address - Fax:313-838-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI017708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty