Provider Demographics
NPI:1689889875
Name:ATTARIAN, GWYNNE MARIE WESLEY (DDS)
Entity Type:Individual
Prefix:
First Name:GWYNNE
Middle Name:MARIE WESLEY
Last Name:ATTARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4353
Mailing Address - Country:US
Mailing Address - Phone:810-360-0330
Mailing Address - Fax:810-229-2965
Practice Address - Street 1:8641 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4353
Practice Address - Country:US
Practice Address - Phone:810-360-0330
Practice Address - Fax:810-229-2965
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010179181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice