Provider Demographics
NPI:1942367628
Name:DENTISTS R US
Entity Type:Organization
Organization Name:DENTISTS R US
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-879-7755
Mailing Address - Street 1:38865 DEQUINDRE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6812
Mailing Address - Country:US
Mailing Address - Phone:248-879-7755
Mailing Address - Fax:248-879-4526
Practice Address - Street 1:38865 DEQUINDRE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6812
Practice Address - Country:US
Practice Address - Phone:248-879-7755
Practice Address - Fax:248-879-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010168291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4169910Medicaid