Provider Demographics
NPI:1558455592
Name:SANILAC FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SANILAC FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-866-2400
Mailing Address - Street 1:3210 BRIARFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9501
Mailing Address - Country:US
Mailing Address - Phone:419-866-2400
Mailing Address - Fax:419-866-5320
Practice Address - Street 1:749 N SANDUSKY RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-9143
Practice Address - Country:US
Practice Address - Phone:810-648-3224
Practice Address - Fax:810-648-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty