Provider Demographics
NPI:1487197802
Name:WASHTENAW DENTAL, PLC
Entity Type:Organization
Organization Name:WASHTENAW DENTAL, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-485-4600
Mailing Address - Street 1:2100 WASHTENAW RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1708
Mailing Address - Country:US
Mailing Address - Phone:734-485-4600
Mailing Address - Fax:734-485-4601
Practice Address - Street 1:2100 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1708
Practice Address - Country:US
Practice Address - Phone:734-485-4600
Practice Address - Fax:734-485-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty