Provider Demographics
NPI:1366172249
Name:WALBY DENTAL PLLC
Entity type:Organization
Organization Name:WALBY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOMONTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-652-9116
Mailing Address - Street 1:435 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1933
Mailing Address - Country:US
Mailing Address - Phone:248-652-9116
Mailing Address - Fax:
Practice Address - Street 1:435 PINE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1933
Practice Address - Country:US
Practice Address - Phone:248-652-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALBY DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty