Provider Demographics
NPI:1760199178
Name:POWELL DENTAL PLLC
Entity Type:Organization
Organization Name:POWELL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISA IRENE POWELL, AS MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-649-1800
Mailing Address - Street 1:19865 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP.
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-479-2200
Mailing Address - Fax:734-479-2202
Practice Address - Street 1:19865 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP.
Practice Address - State:MI
Practice Address - Zip Code:48183
Practice Address - Country:US
Practice Address - Phone:734-479-2200
Practice Address - Fax:734-479-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable