Provider Demographics
NPI:1396921094
Name:ADLAI, EUGENIA (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:
Last Name:ADLAI
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 1:26699 W 12 MILE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1578
Mailing Address - Country:US
Mailing Address - Phone:248-880-1093
Mailing Address - Fax:
Practice Address - Street 1:26699 W 12 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-880-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010161981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice