Healthcare Provider Details

I. General information

NPI: 1619141256
Provider Name (Legal Business Name): GEORGE ATWAN DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 BENSTEIN RD
COMMERCE TOWNSHIP MI
48390-1101
US

IV. Provider business mailing address

2735 BENSTEIN RD
COMMERCE TOWNSHIP MI
48390-1101
US

V. Phone/Fax

Practice location:
  • Phone: 248-624-3010
  • Fax: 248-624-5886
Mailing address:
  • Phone: 248-624-3010
  • Fax: 248-624-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901016989
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number291016802
License Number StateMI

VIII. Authorized Official

Name: DOREEN L ZAFFER
Title or Position: MANAGER
Credential:
Phone: 248-624-3010