Provider Demographics
NPI:1720159296
Name:JANOWICZ, AMY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:JANOWICZ
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 1:1916 ALHAMBRA DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5009
Mailing Address - Country:US
Mailing Address - Phone:734-327-4056
Mailing Address - Fax:
Practice Address - Street 1:24293 TELEGRAPH RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-3011
Practice Address - Country:US
Practice Address - Phone:800-380-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4718290Medicaid