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General NPI Number Information
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NPI Number | 1679581912
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Entity Type | Individual
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Provider Name | ANDRZEJ LUCJAN DOLATA DDS
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 26370 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1463
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Country | US
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Telephone | 313-534-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 BROADWAY ST
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City | ANN ARBOR
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State | MI
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Zip | 48105-1876
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Country | US
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Telephone | 734-678-4143
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 15316
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License Number State | MI
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