Provider Demographics
NPI:1255991204
Name:DAWISHA, DANIELLE LUCY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LUCY
Last Name:DAWISHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 WINDHAM HILL CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2782
Mailing Address - Country:US
Mailing Address - Phone:248-931-2024
Mailing Address - Fax:
Practice Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2413
Practice Address - Country:US
Practice Address - Phone:586-783-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016001651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice