Provider Demographics
NPI:1417439696
Name:DAWN A. DIESING, DDS PLLC
Entity type:Organization
Organization Name:DAWN A. DIESING, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:DIESING
Authorized Official - Last Name:PERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-851-6446
Mailing Address - Street 1:32910 W.13 MILE ROAD
Mailing Address - Street 2:SUITE C-304
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1983
Mailing Address - Country:US
Mailing Address - Phone:248-851-6446
Mailing Address - Fax:248-851-4408
Practice Address - Street 1:32910 W.13 MILE ROAD
Practice Address - Street 2:SUITE C-304
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1983
Practice Address - Country:US
Practice Address - Phone:248-851-6446
Practice Address - Fax:248-851-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty