Healthcare Provider Details

I. General information

NPI: 1902273832
Provider Name (Legal Business Name): MOTOR CITY ORTHODONTIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E FORT ST SUITE 502
DETROIT MI
48226-2940
US

IV. Provider business mailing address

407 E FORT ST SUITE 502
DETROIT MI
48226-2940
US

V. Phone/Fax

Practice location:
  • Phone: 313-769-2030
  • Fax:
Mailing address:
  • Phone: 313-769-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14612
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL L LANZETTA
Title or Position: OWNER
Credential: DDS
Phone: 734-558-4420