Provider Demographics
NPI:1720621659
Name:AO OF TROY PLLC
Entity Type:Organization
Organization Name:AO OF TROY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRZYZANIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-792-8315
Mailing Address - Street 1:3456 SHATTUCK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7013
Mailing Address - Country:US
Mailing Address - Phone:989-792-8315
Mailing Address - Fax:
Practice Address - Street 1:363 W BIG BEAVER RD STE 225
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5242
Practice Address - Country:US
Practice Address - Phone:248-817-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty