Provider Demographics
NPI:1699953315
Name:PESIS DENTAL GROUP, P.C.
Entity type:Organization
Organization Name:PESIS DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:PESIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-478-1650
Mailing Address - Street 1:29224 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5500
Mailing Address - Country:US
Mailing Address - Phone:248-478-1650
Mailing Address - Fax:
Practice Address - Street 1:29224 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5500
Practice Address - Country:US
Practice Address - Phone:248-478-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty