Provider Demographics
NPI:1619141256
Name:GEORGE ATWAN DENTISTRY LLC
Entity Type:Organization
Organization Name:GEORGE ATWAN DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-624-3010
Mailing Address - Street 1:2735 BENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1101
Mailing Address - Country:US
Mailing Address - Phone:248-624-3010
Mailing Address - Fax:248-624-5886
Practice Address - Street 1:2735 BENSTEIN RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-1101
Practice Address - Country:US
Practice Address - Phone:248-624-3010
Practice Address - Fax:248-624-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010169891223G0001X
MI2910168021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty