Provider Demographics
NPI:1710303870
Name:EZ DENTAL PC
Entity Type:Organization
Organization Name:EZ DENTAL PC
Other - Org Name:EXCEL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIMANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-929-9999
Mailing Address - Street 1:2663 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2469
Mailing Address - Country:US
Mailing Address - Phone:734-929-9999
Mailing Address - Fax:
Practice Address - Street 1:2663 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2469
Practice Address - Country:US
Practice Address - Phone:734-929-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty