Provider Demographics
NPI:1770356925
Name:LIVONIA DENTAL OFFICE
Entity type:Organization
Organization Name:LIVONIA DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SESI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-910-1482
Mailing Address - Street 1:28807 8 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2080
Mailing Address - Country:US
Mailing Address - Phone:248-516-5266
Mailing Address - Fax:
Practice Address - Street 1:28807 8 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2080
Practice Address - Country:US
Practice Address - Phone:248-516-5266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty