Provider Demographics
NPI:1760869713
Name:AIMEE VAKULA-ROLLINS, D.D.S., PLLC
Entity Type:Organization
Organization Name:AIMEE VAKULA-ROLLINS, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:VAKULA-ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-653-4447
Mailing Address - Street 1:1044 N. IRISH RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423
Mailing Address - Country:US
Mailing Address - Phone:810-653-4447
Mailing Address - Fax:810-653-7988
Practice Address - Street 1:1044 N. IRISH RD
Practice Address - Street 2:SUITE B
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423
Practice Address - Country:US
Practice Address - Phone:810-653-4447
Practice Address - Fax:810-653-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty