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General NPI Number Information
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NPI Number | 1598979676
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Entity Type | Organization
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Legal Business Name | ELAINE GANTZ, D.D.S., P.C.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 4005 HIGHLAND RD.
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City | WATERFORD
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State | MI
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Zip | 48328-2134
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Country | US
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Telephone | 248-682-4971
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Fax | 248-682-4515
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Provider Business Mailing Address
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Address Line | 4005 HIGHLAND RD.
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City | WATERFORD
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State | MI
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Zip | 48328-2134
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Country | US
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Telephone | 248-682-4971
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Fax | 248-682-4515
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KAREN LOUISE GOERINGER
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Credential | A.B.A
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Telephone | 248-682-4971
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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 | 13299
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License Number State | MI
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