Healthcare Provider Details

I. General information

NPI: 1679923106
Provider Name (Legal Business Name): MARY KARINA DOSTIE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE ROOM 2016
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE ROOM 2016
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-647-4201
  • Fax: 734-615-1415
Mailing address:
  • Phone: 734-647-4201
  • Fax: 734-615-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: