Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Diversified Dental, PC

Organization Dental Clinic/Center · NPI 1669191342

Diversified Dental, PC is a Dental Clinic/Center in Saint Clair Shores, Michigan. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

30231 Jefferson Ave
Saint Clair Shores, MI 48082-1787
Phone: (586) 775-2400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1669191342
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kevin Prush — Dentist · (586) 775-2400
NPI enumeratedAugust 25, 2022
Last updated in NPPESAugust 25, 2022
Certification dateAugust 25, 2022
Mailing address30231 Jefferson Ave, Saint Clair Shores, MI 48082-1787

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