Provider Demographics
NPI:1316544083
Name:MICHIGAN DENTAL WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:MICHIGAN DENTAL WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-695-4300
Mailing Address - Street 1:4025 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7942
Mailing Address - Country:US
Mailing Address - Phone:810-695-4300
Mailing Address - Fax:
Practice Address - Street 1:4025 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7942
Practice Address - Country:US
Practice Address - Phone:810-695-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental