Provider Demographics
NPI:1851323075
Name:NOVI RECONSTRUCTIVE DENTISTRY PC
Entity Type:Organization
Organization Name:NOVI RECONSTRUCTIVE DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WARANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:248-349-7900
Mailing Address - Street 1:42260 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1836
Mailing Address - Country:US
Mailing Address - Phone:248-349-7900
Mailing Address - Fax:248-349-5751
Practice Address - Street 1:42260 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1836
Practice Address - Country:US
Practice Address - Phone:248-349-7900
Practice Address - Fax:248-349-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI142921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty