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General NPI Number Information
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NPI Number | 1457929473
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Entity Type | Organization
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Legal Business Name | FRONCZAK DENTISTRY PLLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 8080 MOORSBRIDGE RD
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City | PORTAGE
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State | MI
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Zip | 49024-4421
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Country | US
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Telephone | 313-515-0465
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Fax |
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Provider Business Mailing Address
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Address Line | 48522 VALLEY CT
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City | PAW PAW
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State | MI
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Zip | 49079-9300
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Country | US
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Telephone | 313-515-0465
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | CHRISTOPHER JOSEPH FRONCZAK
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Credential | DDS
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Telephone | 313-515-0465
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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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