Provider Demographics
NPI:1053748889
Name:DENTAL HYGIENE VISITING SERVICES
Entity type:Organization
Organization Name:DENTAL HYGIENE VISITING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LORAY
Authorized Official - Last Name:MCCLENIC
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:313-407-1400
Mailing Address - Street 1:38 ADELAIDE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-3111
Mailing Address - Country:US
Mailing Address - Phone:313-407-1400
Mailing Address - Fax:313-784-9136
Practice Address - Street 1:38 ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3111
Practice Address - Country:US
Practice Address - Phone:313-407-1400
Practice Address - Fax:313-784-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-12
Last Update Date:2013-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902010375124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty