Provider Demographics
NPI:1780132092
Name:Z DENTAL
Entity type:Organization
Organization Name:Z DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAZNY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-626-4232
Mailing Address - Street 1:32767 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1134
Mailing Address - Country:US
Mailing Address - Phone:248-785-3426
Mailing Address - Fax:
Practice Address - Street 1:32767 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MI
Practice Address - Zip Code:48025-1134
Practice Address - Country:US
Practice Address - Phone:248-785-3426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437271053Medicaid