Provider Demographics
NPI:1972264919
Name:AESTHETIC DENTISTRY BY DIPILLA, P.C.
Entity Type:Organization
Organization Name:AESTHETIC DENTISTRY BY DIPILLA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING AND CREDENTIALING ADMINIS
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:AUSILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-615-6865
Mailing Address - Street 1:600 NORTH OLD WOODWARD
Mailing Address - Street 2:STE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009
Mailing Address - Country:US
Mailing Address - Phone:248-646-0442
Mailing Address - Fax:248-266-9319
Practice Address - Street 1:600 NORTH OLD WOODWARD
Practice Address - Street 2:STE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009
Practice Address - Country:US
Practice Address - Phone:248-646-0442
Practice Address - Fax:248-266-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty