Provider Demographics
NPI:1245392307
Name:WASHTENAW GENERAL DENTISTRY ASSOCIATES
Entity Type:Organization
Organization Name:WASHTENAW GENERAL DENTISTRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARMENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-434-6020
Mailing Address - Street 1:3075 W CLARK ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-434-6020
Mailing Address - Fax:734-434-6151
Practice Address - Street 1:3075 W CLARK ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-434-6020
Practice Address - Fax:734-434-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI167591223G0001X
MI111071223G0001X
MI164291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty