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General NPI Number Information
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NPI Number | 1558072827
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Entity Type | Individual
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Provider Name | MARY BORYSIEWSKI RDH
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Gender | Female
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-845-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 803 WINCHESTER AVE
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City | LINCOLN PARK
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State | MI
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Zip | 48146-3169
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Country | US
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Telephone | 313-207-3011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902011511
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License Number State | MI
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