Provider Demographics
NPI:1982394201
Name:LIVINGSTON COUNTY DENTISTRY PLLC
Entity Type:Organization
Organization Name:LIVINGSTON COUNTY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-431-7930
Mailing Address - Street 1:4392 E. GRAND RIVER
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-202-0073
Mailing Address - Fax:
Practice Address - Street 1:4392 E. GRAND RIVER
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-202-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental