Provider Demographics
NPI:1912076654
Name:FELIX K KORTO DDS PC
Entity Type:Organization
Organization Name:FELIX K KORTO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:K
Authorized Official - Last Name:KORTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-371-5500
Mailing Address - Street 1:18201 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-535-5200
Mailing Address - Fax:313-535-0011
Practice Address - Street 1:18201 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219
Practice Address - Country:US
Practice Address - Phone:313-535-5200
Practice Address - Fax:313-535-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2809250Medicaid
MI1908675Medicare ID - Type Unspecified