Provider Demographics
NPI:1659912525
Name:PAINLESS DENTAL CENTER PC
Entity Type:Organization
Organization Name:PAINLESS DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-651-8041
Mailing Address - Street 1:20720 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1275
Mailing Address - Country:US
Mailing Address - Phone:313-651-8041
Mailing Address - Fax:313-341-7884
Practice Address - Street 1:20720 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1275
Practice Address - Country:US
Practice Address - Phone:313-651-8041
Practice Address - Fax:313-341-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty