Healthcare Provider Details

I. General information

NPI: 1508131160
Provider Name (Legal Business Name): DEXTER DENTAL STUDIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DEXTER ANN ARBOR RD STE 300
DEXTER MI
48130-8598
US

IV. Provider business mailing address

7300 DEXTER ANN ARBOR RD STE 300
DEXTER MI
48130-8598
US

V. Phone/Fax

Practice location:
  • Phone: 734-426-8360
  • Fax: 734-426-8374
Mailing address:
  • Phone: 734-426-8360
  • Fax: 734-426-8374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNELIES S CORNISH
Title or Position: OWNER
Credential: DDS
Phone: 734-426-8360