Provider Demographics
NPI:1538108220
Name:EHLENDT, PETER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:EHLENDT
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 1:18600 NORTHVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3544
Mailing Address - Country:US
Mailing Address - Phone:248-348-9800
Mailing Address - Fax:248-348-3828
Practice Address - Street 1:18600 NORTHVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:248-348-9800
Practice Address - Fax:248-348-3828
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID1103501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice