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General NPI Number Information
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NPI Number | 1336857317
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Entity Type | Organization
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Legal Business Name | OWOSSO DENTAL ASSOCIATES, PC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 109 E WILLIAMS ST
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City | OWOSSO
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State | MI
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Zip | 48867-2360
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Country | US
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Telephone | 989-723-6118
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Fax | 989-729-9588
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Provider Business Mailing Address
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Address Line | 109 E WILLIAMS ST
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City | OWOSSO
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State | MI
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Zip | 48867-2360
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Country | US
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Telephone | 989-723-6118
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Fax | 989-729-9588
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DANA L KONG
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Credential | DDS
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Telephone | 989-723-6118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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