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General NPI Number Information
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NPI Number | 1063171858
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 34121 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-2077
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Country | US
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Telephone | 586-725-2125
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Fax |
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Provider Business Mailing Address
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Address Line | 35395 POUND RD
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City | RICHMOND
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State | MI
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Zip | 48062-5702
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Country | US
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Telephone | 810-278-5970
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DAVID LESINSKI
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Credential | DDS
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Telephone | 810-278-5970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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