Provider Demographics
NPI:1275023897
Name:PEARL DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:PEARL DENTAL GROUP PLLC
Other - Org Name:PEARL DENTAL GROUP PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:ZEHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-563-4626
Mailing Address - Street 1:9324 CONANT ST STE C
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3506
Mailing Address - Country:US
Mailing Address - Phone:313-870-9423
Mailing Address - Fax:313-870-9424
Practice Address - Street 1:9324 CONANT ST STE C
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3506
Practice Address - Country:US
Practice Address - Phone:313-870-9423
Practice Address - Fax:313-870-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty