Provider Demographics
NPI:1427194216
Name:GREAT EXPRESSIONS DENTAL CENTERS DOUGLAS DZIUBA DDS INC
Entity Type:Organization
Organization Name:GREAT EXPRESSIONS DENTAL CENTERS DOUGLAS DZIUBA DDS INC
Other - Org Name:GREAT EXPRESSION DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-1100
Mailing Address - Street 1:29777 TELEGRAPH RD STE 3000
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7634
Mailing Address - Country:US
Mailing Address - Phone:248-203-1100
Mailing Address - Fax:248-203-1112
Practice Address - Street 1:29777 TELEGRAPH RD STE 3000
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7634
Practice Address - Country:US
Practice Address - Phone:248-203-1100
Practice Address - Fax:248-203-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty