Healthcare Provider Details

I. General information

NPI: 1649421868
Provider Name (Legal Business Name): ALESSANDRA DAGOSTIN DDS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 PACKARD ST STE B
ANN ARBOR MI
48108-2090
US

IV. Provider business mailing address

2765 MANCHESTER RD
ANN ARBOR MI
48104-6571
US

V. Phone/Fax

Practice location:
  • Phone: 734-975-0100
  • Fax:
Mailing address:
  • Phone: 734-418-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: