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Organization
MIKE KOSTAKOS, DDS, P.C.
Active
Organization
MIKE KOSTAKOS, DDS, P.C.
Active
Other names
Southfield Dentistry, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
WALA SALAMA (OFFICE MANAGER)
(248) 559-1220
Entity
Organization
Contact information
Practice address
20307 W 12 MILE RD STE 101, SOUTHFIELD, MI 48076-5407
(248) 559-1220
(248) 559-4300
Mailing address
20307 W 12 MILE RD STE 101, SOUTHFIELD, MI 48076-5407
(248) 559-1220
(248) 559-4300
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700932241
—
MI
Enumeration date
01/26/2023
Last updated
01/26/2023
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