Provider Demographics
NPI:1306462577
Name:DETROIT DENTAL COMPANY
Entity type:Organization
Organization Name:DETROIT DENTAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-547-7700
Mailing Address - Street 1:1665 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2121
Mailing Address - Country:US
Mailing Address - Phone:248-547-7700
Mailing Address - Fax:248-547-6054
Practice Address - Street 1:1665 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2121
Practice Address - Country:US
Practice Address - Phone:248-547-7700
Practice Address - Fax:248-547-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty