Provider Demographics
NPI:1225115884
Name:DZIUBA, DOUGLAS F (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:F
Last Name:DZIUBA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51111 PLYMOUTH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:739-454-7268
Mailing Address - Fax:
Practice Address - Street 1:25923 WEST WARREN
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:313-561-3372
Practice Address - Fax:313-561-0817
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI109601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics