Healthcare Provider Details

I. General information

NPI: 1124789334
Provider Name (Legal Business Name): DEERFIELD FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 N LAPEER RD STE A
NORTH BRANCH MI
48461-9660
US

IV. Provider business mailing address

5830 N LAPEER RD STE A
NORTH BRANCH MI
48461-9660
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-7800
  • Fax:
Mailing address:
  • Phone: 810-793-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. OLA SITTO
Title or Position: OWNER
Credential: DDS PC
Phone: 810-793-7800