Provider Demographics
NPI:1396240354
Name:WILLIAM G. ZIECINA, D.D.S., P.C.
Entity type:Organization
Organization Name:WILLIAM G. ZIECINA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CHASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-219-7722
Mailing Address - Street 1:22025 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2333
Mailing Address - Country:US
Mailing Address - Phone:248-709-0777
Mailing Address - Fax:
Practice Address - Street 1:52975 VAN DYKE AVE STE 303
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3544
Practice Address - Country:US
Practice Address - Phone:248-709-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI273504940261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental