Provider Demographics
NPI:1841491248
Name:HANLEY L. KAISER DDS PC
Entity type:Organization
Organization Name:HANLEY L. KAISER DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANLEY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-759-5353
Mailing Address - Street 1:23105 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1622
Mailing Address - Country:US
Mailing Address - Phone:586-759-5353
Mailing Address - Fax:586-759-0044
Practice Address - Street 1:23105 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1622
Practice Address - Country:US
Practice Address - Phone:586-759-5353
Practice Address - Fax:586-759-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010098471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty