Provider Demographics
NPI:1447594080
Name:NEW BALTIMORE DENTAL CENTER
Entity Type:Organization
Organization Name:NEW BALTIMORE DENTAL CENTER
Other - Org Name:DENTAL CENTER OF NEW BALTIMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:OKONOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-530-1135
Mailing Address - Street 1:33497 23 MILE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33497 23 MILE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4062
Practice Address - Country:US
Practice Address - Phone:586-725-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty