Provider Demographics
NPI:1376843136
Name:EIGHT MILE DENTAL SPECIALISTS PC
Entity Type:Organization
Organization Name:EIGHT MILE DENTAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUGENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-454-4800
Mailing Address - Street 1:PO BOX 38367
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-0367
Mailing Address - Country:US
Mailing Address - Phone:313-454-4800
Mailing Address - Fax:313-341-7867
Practice Address - Street 1:511 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1004
Practice Address - Country:US
Practice Address - Phone:313-454-4800
Practice Address - Fax:313-341-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty