Provider Demographics
NPI:1174031264
Name:JOHN L. AURELIA, D.D.S., PLLC
Entity Type:Organization
Organization Name:JOHN L. AURELIA, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:AURELIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-651-6810
Mailing Address - Street 1:804 N. MAIN ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-651-6810
Mailing Address - Fax:248-651-0697
Practice Address - Street 1:804 N. MAIN ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-651-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186041223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty