Provider Demographics
NPI:1457854333
Name:NICHOLAS J PELACHYK DDS PC
Entity Type:Organization
Organization Name:NICHOLAS J PELACHYK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WIFE
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:TRANG
Authorized Official - Last Name:PELACHYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-914-5506
Mailing Address - Street 1:42372 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2535
Mailing Address - Country:US
Mailing Address - Phone:734-546-0042
Mailing Address - Fax:
Practice Address - Street 1:301 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-9744
Practice Address - Country:US
Practice Address - Phone:734-546-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental