Provider Demographics
NPI:1194813535
Name:MORTIERE AND GASPAROTTO DDS PC
Entity type:Organization
Organization Name:MORTIERE AND GASPAROTTO DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CALLISTO
Authorized Official - Last Name:GASPAROTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-459-1950
Mailing Address - Street 1:5958 N CANTON CENTER RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2766
Mailing Address - Country:US
Mailing Address - Phone:734-459-1950
Mailing Address - Fax:734-459-5710
Practice Address - Street 1:5958 N CANTON CENTER RD STE 600
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2766
Practice Address - Country:US
Practice Address - Phone:734-459-1950
Practice Address - Fax:734-459-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0148431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty