Provider Demographics
NPI:1942800776
Name:DELUXE DENTAL
Entity Type:Organization
Organization Name:DELUXE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-820-7766
Mailing Address - Street 1:3760 S DORT HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2045
Mailing Address - Country:US
Mailing Address - Phone:810-820-7766
Mailing Address - Fax:
Practice Address - Street 1:23350 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2496
Practice Address - Country:US
Practice Address - Phone:248-968-2725
Practice Address - Fax:248-466-0032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELUXE DENTAL ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty