Provider Demographics
NPI:1346976107
Name:ONA R ERDT, DMD, PLLC
Entity Type:Organization
Organization Name:ONA R ERDT, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ONA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSHS
Authorized Official - Phone:734-812-2832
Mailing Address - Street 1:1014 N CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1092
Mailing Address - Country:US
Mailing Address - Phone:734-812-2832
Mailing Address - Fax:
Practice Address - Street 1:1014 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1092
Practice Address - Country:US
Practice Address - Phone:734-812-2832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental