Provider Demographics
NPI:1629230859
Name:WARREN DENTAL REFLECTIONS, PLC
Entity Type:Organization
Organization Name:WARREN DENTAL REFLECTIONS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-573-7500
Mailing Address - Street 1:11552 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2644
Mailing Address - Country:US
Mailing Address - Phone:586-573-7500
Mailing Address - Fax:586-573-7502
Practice Address - Street 1:11552 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2644
Practice Address - Country:US
Practice Address - Phone:586-573-7500
Practice Address - Fax:586-573-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty