Provider Demographics
NPI:1598979676
Name:ELAINE GANTZ, D.D.S., P.C.
Entity type:Organization
Organization Name:ELAINE GANTZ, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GOERINGER
Authorized Official - Suffix:
Authorized Official - Credentials:ABA
Authorized Official - Phone:248-682-4971
Mailing Address - Street 1:4005 HIGHLAND RD.
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2134
Mailing Address - Country:US
Mailing Address - Phone:248-682-4971
Mailing Address - Fax:248-682-4515
Practice Address - Street 1:4005 HIGHLAND RD.
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2134
Practice Address - Country:US
Practice Address - Phone:248-682-4971
Practice Address - Fax:248-682-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty