Provider Demographics
NPI:1609058981
Name:VERDERESE, DOMINIC FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:FRANK
Last Name:VERDERESE
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 1:4713 M 61
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9422
Mailing Address - Country:US
Mailing Address - Phone:989-846-7000
Mailing Address - Fax:
Practice Address - Street 1:47 HARBOUR VIEW PT
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MI
Practice Address - Zip Code:48634-9479
Practice Address - Country:US
Practice Address - Phone:989-697-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist