Provider Demographics
NPI:1952666117
Name:MICHIGAN'S DENTAL HEALTH PROFESSIONAL
Entity Type:Organization
Organization Name:MICHIGAN'S DENTAL HEALTH PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-254-3860
Mailing Address - Street 1:42370 VAN DYKE AVE SUITE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-254-3860
Mailing Address - Fax:586-254-6575
Practice Address - Street 1:42370 VAN DYKE AVE SUITE 101
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-254-3860
Practice Address - Fax:586-254-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty