Provider Demographics
NPI:1891817631
Name:MARK GERALD FRIZZO DDS PLLC
Entity Type:Organization
Organization Name:MARK GERALD FRIZZO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FRIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-855-3435
Mailing Address - Street 1:31300 LUDDEN
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1433
Mailing Address - Country:US
Mailing Address - Phone:248-855-3435
Mailing Address - Fax:248-855-3437
Practice Address - Street 1:31300 LUDDEN
Practice Address - Street 2:SUITE B
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1433
Practice Address - Country:US
Practice Address - Phone:248-855-3435
Practice Address - Fax:248-855-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty