Provider Demographics
NPI:1437456548
Name:GWYNNE ATTARIAN DDS PLLC
Entity Type:Organization
Organization Name:GWYNNE ATTARIAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-360-0330
Mailing Address - Street 1:8641 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4353
Mailing Address - Country:US
Mailing Address - Phone:810-360-0330
Mailing Address - Fax:810-229-2965
Practice Address - Street 1:8641 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4353
Practice Address - Country:US
Practice Address - Phone:810-360-0330
Practice Address - Fax:810-229-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty