Provider Demographics
NPI:1851750608
Name:ONYX AND DEDICATED DENTAL SERVICES
Entity Type:Organization
Organization Name:ONYX AND DEDICATED DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST/OFFICE ADMINISTRAT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:248-763-3384
Mailing Address - Street 1:645 GRISWOLD ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4105
Mailing Address - Country:US
Mailing Address - Phone:313-263-0230
Mailing Address - Fax:313-263-0320
Practice Address - Street 1:645 GRISWOLD ST
Practice Address - Street 2:SUITE 224
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4105
Practice Address - Country:US
Practice Address - Phone:313-263-0230
Practice Address - Fax:313-263-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902003560305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization