Provider Demographics
NPI:1073853453
Name:WOMACK DENTAL PC.
Entity Type:Organization
Organization Name:WOMACK DENTAL PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-392-6005
Mailing Address - Street 1:20720 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1275
Mailing Address - Country:US
Mailing Address - Phone:313-342-1997
Mailing Address - Fax:313-416-1405
Practice Address - Street 1:20720 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1275
Practice Address - Country:US
Practice Address - Phone:313-342-1997
Practice Address - Fax:313-416-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty