Provider Demographics
NPI:1629242805
Name:CONVENIENT TR PC
Entity Type:Organization
Organization Name:CONVENIENT TR PC
Other - Org Name:CONVENIENT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-723-1450
Mailing Address - Street 1:2290 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3616
Mailing Address - Country:US
Mailing Address - Phone:734-676-0373
Mailing Address - Fax:734-676-6056
Practice Address - Street 1:2290 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-3616
Practice Address - Country:US
Practice Address - Phone:734-676-0373
Practice Address - Fax:734-676-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty