Healthcare Provider Details

I. General information

NPI: 1649258609
Provider Name (Legal Business Name): GREGORY M. OKONIEWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 AUBURN RD SUITE 100
AUBURN HILLS MI
48326-3322
US

IV. Provider business mailing address

3916 AUBURN RD SUITE 100
AUBURN HILLS MI
48326-3322
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-1820
  • Fax: 248-852-1056
Mailing address:
  • Phone: 248-852-1820
  • Fax: 248-852-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13796
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: