Provider Demographics
NPI:1578335014
Name:MICHIGAN DENTAL TEAM, PLLC
Entity Type:Organization
Organization Name:MICHIGAN DENTAL TEAM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-805-5577
Mailing Address - Street 1:182 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-8626
Mailing Address - Country:US
Mailing Address - Phone:717-759-4375
Mailing Address - Fax:717-759-4336
Practice Address - Street 1:30671 STEPHENSON HWY STE F
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1651
Practice Address - Country:US
Practice Address - Phone:717-759-4375
Practice Address - Fax:717-759-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty