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General NPI Number Information
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NPI Number | 1487197802
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Entity Type | Organization
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Legal Business Name | WASHTENAW DENTAL, PLC
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Dates
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Enumeration Date | 12/03/2016
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Last Update Date | 12/03/2016
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Provider Practice Location Address
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Address Line | 2100 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1708
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Country | US
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Telephone | 734-485-4600
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Fax | 734-485-4601
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Provider Business Mailing Address
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Address Line | 2100 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1708
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Country | US
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Telephone | 734-485-4600
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Fax | 734-485-4601
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Authorized Official
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Title or Position | DENTIST
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Name | DENNIS DONOHO
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Credential |
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Telephone | 734-485-4600
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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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