Provider Demographics
NPI:1043914351
Name:SDPA2 PLLC
Entity Type:Organization
Organization Name:SDPA2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-212-9762
Mailing Address - Street 1:7 W SQUARE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-282-0520
Practice Address - Street 1:4721 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3565
Practice Address - Country:US
Practice Address - Phone:248-673-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental