Provider Demographics
NPI:1871631168
Name:AESTHETIC PERIODONTOLOGY
Entity Type:Organization
Organization Name:AESTHETIC PERIODONTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOUYIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-373-3377
Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-373-3377
Mailing Address - Fax:248-373-3388
Practice Address - Street 1:2251 N SQUIRREL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4600
Practice Address - Country:US
Practice Address - Phone:248-373-3377
Practice Address - Fax:248-373-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI192001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty