Provider Demographics
NPI:1720067697
Name:PASIKOWSKI, DOROTHY (DDS)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:PASIKOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1411
Mailing Address - Country:US
Mailing Address - Phone:248-547-7110
Mailing Address - Fax:248-547-7176
Practice Address - Street 1:2867 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1411
Practice Address - Country:US
Practice Address - Phone:248-547-7110
Practice Address - Fax:248-547-7176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010165391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice