Provider Demographics
NPI:1306561576
Name:MIDENTALONE
Entity type:Organization
Organization Name:MIDENTALONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-245-5083
Mailing Address - Street 1:111 ROCHDALE DR S STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2274
Mailing Address - Country:US
Mailing Address - Phone:248-652-1020
Mailing Address - Fax:248-652-1022
Practice Address - Street 1:111 ROCHDALE DR S STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2274
Practice Address - Country:US
Practice Address - Phone:248-652-1020
Practice Address - Fax:248-652-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty