Provider Demographics
NPI:1679302764
Name:WEST BLOOMFIELD DENTISTRY, PLLC
Entity type:Organization
Organization Name:WEST BLOOMFIELD DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-682-2550
Mailing Address - Street 1:2040 WOODROW WILSON DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324
Mailing Address - Country:US
Mailing Address - Phone:248-682-2550
Mailing Address - Fax:
Practice Address - Street 1:2040 WOODROW WILSON BLVD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1772
Practice Address - Country:US
Practice Address - Phone:248-682-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental