Provider Demographics
NPI:1184822579
Name:PARGOFF DEFAZIO, ANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:PARGOFF DEFAZIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 E HIGHLAND RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:810-632-2241
Mailing Address - Fax:810-632-6455
Practice Address - Street 1:9500 E HIGHLAND RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:810-632-2241
Practice Address - Fax:810-632-6455
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18253001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice