| Gantz Dds Pllc | |
|
25865 W 12 Mile Rd Southfield MI 48034-1817 | |
| (248) 353-4010 | |
| (248) 353-0829 |
| Full Name | Gantz Dds Pllc |
|---|---|
| Speciality | Dentist |
| Location | 25865 W 12 Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | Elaine K Gantz (OWNER) |
| Authorized Official Contact | 2483534010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gantz Dds Pllc 25865 W 12 Mile Rd Southfield MI 48034-1817 Ph: (248) 353-4010 | Gantz Dds Pllc 25865 W 12 Mile Rd Southfield MI 48034-1817 Ph: (248) 353-4010 |
| NPI Number | 1700269735 |
|---|---|
| Provider Enumeration Date | 07/08/2015 |
| Last Update Date | 04/12/2016 |
| Medicare PECOS PAC ID | 4486952132 |
|---|---|
| Medicare Enrollment ID | O20160412002706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700269735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901013299 (Michigan) | Primary |
| Provider Name | Neena K Leverenz |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1336582162 PECOS PAC ID: 7416263041 Enrollment ID: I20150827002385 |
| Provider Name | Elaine K Gantz |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1013996537 PECOS PAC ID: 4385950914 Enrollment ID: I20160414000958 |
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