Healthcare Provider Details

I. General information

NPI: 1407440399
Provider Name (Legal Business Name): NEW YOU DENTAL MANAGEMENT- LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E GRAND RIVER AVE
LANSING MI
48912-4749
US

IV. Provider business mailing address

23225 NORTHWESTERN HWY
SOUTHFIELD MI
48075-7707
US

V. Phone/Fax

Practice location:
  • Phone: 248-595-0161
  • Fax:
Mailing address:
  • Phone: 248-595-0161
  • Fax: 248-281-5128

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: JANE PAISOPOULOS
Title or Position: CHIEF OPERATIONS OFFICER
Credential: COO
Phone: 248-595-0161