Provider Demographics
NPI:1891742607
Name:ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-647-7930
Mailing Address - Street 1:15870 19 MILE ROAD
Mailing Address - Street 2:STE 110
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-286-3390
Mailing Address - Fax:
Practice Address - Street 1:15870 19 MILE ROAD
Practice Address - Street 2:STE 110
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-286-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty