Provider Demographics
NPI:1881735066
Name:ERICH A. DITTMAR, DDS, MSD, PC
Entity type:Organization
Organization Name:ERICH A. DITTMAR, DDS, MSD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DITTMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-225-9630
Mailing Address - Street 1:10415 E. GRAND RIVER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-225-9630
Mailing Address - Fax:
Practice Address - Street 1:10415 GRAND RIVER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6533
Practice Address - Country:US
Practice Address - Phone:810-225-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty