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General NPI Number Information
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NPI Number | 1366172249
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Entity Type | Organization
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Legal Business Name | WALBY DENTAL PLLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 435 PINE ST
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City | ROCHESTER
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State | MI
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Zip | 48307-1933
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Country | US
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Telephone | 248-652-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 435 PINE ST
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City | ROCHESTER
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State | MI
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Zip | 48307-1933
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Country | US
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Telephone | 248-652-9116
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLY CHOMONTOWSKI
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Credential |
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Telephone | 248-652-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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