Provider Demographics
NPI:1447640040
Name:GROSSE POINTE FAMILY DENTISTRY MACOMB
Entity type:Organization
Organization Name:GROSSE POINTE FAMILY DENTISTRY MACOMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PANAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-286-7337
Mailing Address - Street 1:46401 ROMEO PLANK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-3510
Mailing Address - Country:US
Mailing Address - Phone:586-286-7337
Mailing Address - Fax:586-286-9974
Practice Address - Street 1:46401 ROMEO PLANK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-3510
Practice Address - Country:US
Practice Address - Phone:586-286-7337
Practice Address - Fax:586-286-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI135711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty