Healthcare Provider Details

I. General information

NPI: 1972271823
Provider Name (Legal Business Name): AT32DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32560 UTICA RD
FRASER MI
48026-2215
US

IV. Provider business mailing address

6233 LINDSAY CT
WEST BLOOMFIELD MI
48324-2154
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-8530
  • Fax:
Mailing address:
  • Phone: 248-660-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAWAR SILEEWA
Title or Position: DENTIST
Credential:
Phone: 248-660-5781