Provider Demographics
NPI:1225587959
Name:MILFORD FAMILY DENTISTRY, PLC
Entity Type:Organization
Organization Name:MILFORD FAMILY DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-684-0042
Mailing Address - Street 1:402 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1967
Mailing Address - Country:US
Mailing Address - Phone:248-684-0042
Mailing Address - Fax:248-684-0366
Practice Address - Street 1:402 UNION ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1967
Practice Address - Country:US
Practice Address - Phone:248-684-0042
Practice Address - Fax:248-684-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty