Provider Demographics
NPI:1598443483
Name:MICHAEL DIREZZE, DDS, PLLC
Entity Type:Organization
Organization Name:MICHAEL DIREZZE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIREZZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-223-8189
Mailing Address - Street 1:20323 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1717
Mailing Address - Country:US
Mailing Address - Phone:313-881-0077
Mailing Address - Fax:
Practice Address - Street 1:20323 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1717
Practice Address - Country:US
Practice Address - Phone:313-881-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty