Provider Demographics
NPI:1013123488
Name:BORTOLOTTI, DANIEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAVID
Last Name:BORTOLOTTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51863 SCHOENHERR RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2757
Mailing Address - Country:US
Mailing Address - Phone:586-731-6300
Mailing Address - Fax:586-731-6011
Practice Address - Street 1:51863 SCHOENHERR RD.
Practice Address - Street 2:SUITE 104
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-5867
Practice Address - Country:US
Practice Address - Phone:586-731-6300
Practice Address - Fax:586-731-6011
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015401122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist