Provider Demographics
NPI:1679199384
Name:LAURICH DENTISTRY LIVONIA
Entity Type:Organization
Organization Name:LAURICH DENTISTRY LIVONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:OCTAVIA
Authorized Official - Last Name:KARACSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-476-1960
Mailing Address - Street 1:18618 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3585
Mailing Address - Country:US
Mailing Address - Phone:248-476-1960
Mailing Address - Fax:248-479-2805
Practice Address - Street 1:18618 MIDDLEBELT RD STE 105
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3586
Practice Address - Country:US
Practice Address - Phone:248-476-1960
Practice Address - Fax:248-479-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty