Provider Demographics
NPI:1568655041
Name:MUIR, DAVID SCOTT
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:MUIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WALTON BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6917
Mailing Address - Country:US
Mailing Address - Phone:248-650-9050
Mailing Address - Fax:248-650-0389
Practice Address - Street 1:1202 WALTON BLVD STE 213
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6917
Practice Address - Country:US
Practice Address - Phone:248-650-9050
Practice Address - Fax:248-650-0389
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019700122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist