Provider Demographics
NPI:1346892445
Name:CAROLINE OKONKOWSKI DMD PC
Entity Type:Organization
Organization Name:CAROLINE OKONKOWSKI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:313-292-5590
Mailing Address - Street 1:25650 GODDARD RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6242
Mailing Address - Country:US
Mailing Address - Phone:313-292-5590
Mailing Address - Fax:313-908-7575
Practice Address - Street 1:25650 GODDARD RD STE A
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6242
Practice Address - Country:US
Practice Address - Phone:313-292-5590
Practice Address - Fax:313-908-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental