Provider Demographics
NPI:1821046996
Name:KAMINSKI, CHARLES THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43230 GARFIELD RD
Mailing Address - Street 2:STE 180
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1162
Mailing Address - Country:US
Mailing Address - Phone:586-226-4080
Mailing Address - Fax:586-226-4435
Practice Address - Street 1:43230 GARFIELD RD
Practice Address - Street 2:STE 180
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1162
Practice Address - Country:US
Practice Address - Phone:586-226-4080
Practice Address - Fax:586-226-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010132211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836945Medicaid