Provider Demographics
NPI:1851510689
Name:RAMINTA I. MASTIS, D.D.S., P.C.
Entity type:Organization
Organization Name:RAMINTA I. MASTIS, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-778-3870
Mailing Address - Street 1:22621 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1821
Mailing Address - Country:US
Mailing Address - Phone:586-778-3870
Mailing Address - Fax:586-778-9469
Practice Address - Street 1:22621 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1821
Practice Address - Country:US
Practice Address - Phone:586-778-3870
Practice Address - Fax:586-778-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty