Provider Demographics
NPI:1215297676
Name:NEW YOU WONDERLAND MANAGEMENT- LIVONIA
Entity type:Organization
Organization Name:NEW YOU WONDERLAND MANAGEMENT- LIVONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAISOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-595-0161
Mailing Address - Street 1:23225 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7707
Mailing Address - Country:US
Mailing Address - Phone:248-595-0161
Mailing Address - Fax:248-799-7575
Practice Address - Street 1:29475 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2112
Practice Address - Country:US
Practice Address - Phone:734-237-5755
Practice Address - Fax:734-237-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty