Provider Demographics
NPI:1124391909
Name:MY URGENT DENTISTRY PLLC
Entity Type:Organization
Organization Name:MY URGENT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARESTEA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAKARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:877-734-3131
Mailing Address - Street 1:21100 ALLEN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1694
Mailing Address - Country:US
Mailing Address - Phone:877-734-3131
Mailing Address - Fax:734-675-7128
Practice Address - Street 1:21100 ALLEN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1694
Practice Address - Country:US
Practice Address - Phone:877-734-3131
Practice Address - Fax:734-675-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty