Provider Demographics
NPI:1114638467
Name:CASEVILLE FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:CASEVILLE FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WLOSZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-805-8052
Mailing Address - Street 1:45861 KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5962
Mailing Address - Country:US
Mailing Address - Phone:586-805-8052
Mailing Address - Fax:
Practice Address - Street 1:6982 MAIN ST
Practice Address - Street 2:
Practice Address - City:CASEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48725-5110
Practice Address - Country:US
Practice Address - Phone:586-805-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty