Provider Demographics
NPI:1437391281
Name:FRASER OKONKOWSKI, CAROLINE (DMD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:FRASER OKONKOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25650 GODDARD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180
Mailing Address - Country:US
Mailing Address - Phone:313-292-5590
Mailing Address - Fax:313-291-1419
Practice Address - Street 1:25650 GODDARD RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-292-5590
Practice Address - Fax:313-291-1419
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist