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General NPI Number Information
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NPI Number | 1649664269
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Entity Type | Organization
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Legal Business Name | DAWN AG KULONGOWSKI, DDS, PC
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 124 N SAGINAW ST SUITE C
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City | HOLLY
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State | MI
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Zip | 48442-1687
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Country | US
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Telephone | 248-634-1976
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Fax | 248-634-2414
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Provider Business Mailing Address
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Address Line | 124 N SAGINAW ST SUITE C
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City | HOLLY
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State | MI
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Zip | 48442-1687
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Country | US
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Telephone | 248-634-1976
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Fax | 248-634-2414
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRIS WAGNER
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Credential |
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Telephone | 248-634-1976
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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 | 2901018388
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License Number State | MI
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