Provider Demographics
NPI:1356527378
Name:KAMINSKI JR., NORBERT J (DDS)
Entity type:Individual
Prefix:
First Name:NORBERT
Middle Name:J
Last Name:KAMINSKI JR.
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 1:16211 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4334
Mailing Address - Country:US
Mailing Address - Phone:586-757-6453
Mailing Address - Fax:586-779-2289
Practice Address - Street 1:16211 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4334
Practice Address - Country:US
Practice Address - Phone:586-757-6453
Practice Address - Fax:586-779-2289
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist