Provider Demographics
NPI:1487867362
Name:PYATENKO, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PYATENKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W NORTH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1550
Mailing Address - Country:US
Mailing Address - Phone:810-227-4200
Mailing Address - Fax:
Practice Address - Street 1:121 W NORTH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1550
Practice Address - Country:US
Practice Address - Phone:810-227-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice