Provider Demographics
NPI:1558126763
Name:EZ DENTIST PLLC
Entity Type:Organization
Organization Name:EZ DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:HARJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-915-0015
Mailing Address - Street 1:27072 DEBIASI DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:313-915-0015
Mailing Address - Fax:
Practice Address - Street 1:27150 PROVIDENCE PKWY STE B
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1272
Practice Address - Country:US
Practice Address - Phone:280-270-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty