Provider Demographics
NPI:1861662264
Name:BRIAN J. POLIDORI DDS PC
Entity Type:Organization
Organization Name:BRIAN J. POLIDORI DDS PC
Other - Org Name:POLIDORI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLIDORI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-274-4422
Mailing Address - Street 1:22701 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2574
Mailing Address - Country:US
Mailing Address - Phone:313-274-4422
Mailing Address - Fax:313-274-7092
Practice Address - Street 1:22701 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2574
Practice Address - Country:US
Practice Address - Phone:313-274-4422
Practice Address - Fax:313-274-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010160471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty