Healthcare Provider Details

I. General information

NPI: 1174239420
Provider Name (Legal Business Name): DIONISE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S GRAND AVE
LANSING MI
48933-2407
US

IV. Provider business mailing address

610 S GRAND AVE
LANSING MI
48933-2407
US

V. Phone/Fax

Practice location:
  • Phone: 517-484-8910
  • Fax: 517-482-2128
Mailing address:
  • Phone: 517-484-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDY BARONE
Title or Position: FRONT OFFICE
Credential:
Phone: 517-484-8910