MEDICARE: DIONISE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center
2	122300000X	Dentist

General Provider Information

NPI Number	:	1174239420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIONISE DENTAL

Provider Business Mailing Address
First Line	:	610 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2407
Country	:	US
Telephone Number	:	517-484-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-2407
Country	:	US
Telephone Number	:	517-484-8910
Fax Number	:	517-482-2128

Authorized Official
Title or Position	:	FRONT OFFICE
Name	:	WENDY BARONE
Credential	:
Telephone Number	:	517-484-8910

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	02/20/2023

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Directions to “DIONISE DENTAL ” Practice Location

Language	Start Address	Practice Location

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