Provider Demographics
NPI:1417237314
Name:JOSEPH M SERRA DDS PLC
Entity Type:Organization
Organization Name:JOSEPH M SERRA DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-380-9330
Mailing Address - Street 1:42010 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1831
Mailing Address - Country:US
Mailing Address - Phone:248-380-9330
Mailing Address - Fax:248-380-9359
Practice Address - Street 1:42010 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1831
Practice Address - Country:US
Practice Address - Phone:248-380-9330
Practice Address - Fax:248-380-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty