Provider Demographics
NPI:1649712670
Name:MICHAEL PETROUNEAS DDS PC
Entity type:Organization
Organization Name:MICHAEL PETROUNEAS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROUNEAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-242-6482
Mailing Address - Street 1:122 COLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4104
Mailing Address - Country:US
Mailing Address - Phone:734-242-3311
Mailing Address - Fax:734-242-6482
Practice Address - Street 1:122 COLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4104
Practice Address - Country:US
Practice Address - Phone:734-242-3311
Practice Address - Fax:734-242-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty