Healthcare Provider Details

I. General information

NPI: 1407773815
Provider Name (Legal Business Name): MINDY LYNN DASSANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 W BRISTOL ROAD
FLINT MI
48507
US

IV. Provider business mailing address

1056 W BRISTOL ROAD
FLINT MI
48507
US

V. Phone/Fax

Practice location:
  • Phone: 810-238-0483
  • Fax: 810-239-5518
Mailing address:
  • Phone: 810-238-0483
  • Fax: 810-239-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: