Provider Demographics
NPI:1013446277
Name:MICHAEL J DELAURA DDS PC
Entity Type:Organization
Organization Name:MICHAEL J DELAURA DDS PC
Other - Org Name:DELAURA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DELAURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-752-2273
Mailing Address - Street 1:410 S MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-5233
Mailing Address - Country:US
Mailing Address - Phone:586-752-2273
Mailing Address - Fax:586-336-7632
Practice Address - Street 1:410 S MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5233
Practice Address - Country:US
Practice Address - Phone:586-752-2273
Practice Address - Fax:586-336-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012968261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental