Provider Demographics
NPI:1962952770
Name:DELUXE DENTAL
Entity type:Organization
Organization Name:DELUXE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHA KIZY
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:810-285-8361
Mailing Address - Street 1:3617 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3830
Mailing Address - Country:US
Mailing Address - Phone:810-285-8361
Mailing Address - Fax:810-259-2073
Practice Address - Street 1:3617 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3830
Practice Address - Country:US
Practice Address - Phone:810-285-8361
Practice Address - Fax:810-259-2073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELUXE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty