Provider Demographics
NPI:1538551460
Name:CONVENIENT MR PC
Entity type:Organization
Organization Name:CONVENIENT MR PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MGR.
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-542-9700
Mailing Address - Street 1:2655 OAKLEY PARK DR.
Mailing Address - Street 2:SUITE #105
Mailing Address - City:COMMERCE TWP.
Mailing Address - State:MI
Mailing Address - Zip Code:48390
Mailing Address - Country:US
Mailing Address - Phone:248-542-9700
Mailing Address - Fax:248-669-0561
Practice Address - Street 1:7500 N. TELEGRAPH RD.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-586-2400
Practice Address - Fax:734-586-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty