Provider Demographics
NPI:1740542323
Name:DENTAL HEALTH AND WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:DENTAL HEALTH AND WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-269-1600
Mailing Address - Street 1:755 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4900
Mailing Address - Country:US
Mailing Address - Phone:248-269-1600
Mailing Address - Fax:248-269-6990
Practice Address - Street 1:755 W BIG BEAVER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4900
Practice Address - Country:US
Practice Address - Phone:248-269-1600
Practice Address - Fax:248-269-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty