Provider Demographics
NPI:1750515383
Name:ART DENTAL CENTER PLLC
Entity type:Organization
Organization Name:ART DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANCA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NASTASA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-507-4046
Mailing Address - Street 1:4935 CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-3801
Mailing Address - Country:US
Mailing Address - Phone:248-507-4046
Mailing Address - Fax:
Practice Address - Street 1:23030 MOONEY ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3240
Practice Address - Country:US
Practice Address - Phone:248-486-4619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty