Provider Demographics
NPI:1477652261
Name:KAZANOWSKI, JOHN E (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:KAZANOWSKI
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 TELEGRAPH RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-433-6000
Mailing Address - Fax:248-433-3650
Practice Address - Street 1:31700 TELEGRAPH RD
Practice Address - Street 2:STE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-433-6000
Practice Address - Fax:248-433-3650
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID122461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice