=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417439696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWN A. DIESING, DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2018
-----------------------------------------------------
Last Update Date | 09/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32910 W.13 MILE ROAD SUITE C-304
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-851-6446
-----------------------------------------------------
Fax | 248-851-4408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32910 W.13 MILE ROAD SUITE C-304
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-851-6446
-----------------------------------------------------
Fax | 248-851-4408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAWN DIESING PERRETT
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 248-851-6446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901014703
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------