Healthcare Provider Details

I. General information

NPI: 1881982973
Provider Name (Legal Business Name): CHARLETTA DENNIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD.
SALINE MI
48176
US

IV. Provider business mailing address

8303 PLATT RD
SALINE MI
48176-9773
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4428
  • Fax:
Mailing address:
  • Phone: 734-295-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301099414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: