Healthcare Provider Details

I. General information

NPI: 1104015080
Provider Name (Legal Business Name): DENTALEXPRESS.NET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23225 NORTHWESTERN HWY
SOUTHFIELD MI
48075-7707
US

IV. Provider business mailing address

23225 NORTHWESTERN HWY
SOUTHFIELD MI
48075-7707
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-9757
  • Fax: 248-799-7575
Mailing address:
  • Phone: 248-352-9757
  • Fax: 248-799-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE PAISOPOULOS
Title or Position: PRESIDENT
Credential:
Phone: 248-352-9757