# GANTZ, D.D.S., P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** elaine Gantz, D.D.S.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356511950
- **Authorized official:** DR. ELAINE K GANTZ DDS (OWNER)
- **Authorized official phone:** (248) 353-4010

## Contact information

- **Practice address:** 25865 W 12 MILE RD, SUITE D-112, SOUTHFIELD, MI 48034-1817
- **Practice address phone:** (248) 353-4010
- **Practice address fax:** (248) 353-0829
- **Mailing address:** 25865 W 12 MILE RD, SUITE D-112, SOUTHFIELD, MI 48034-1817
- **Mailing address phone:** (248) 353-4010
- **Mailing address fax:** (248) 353-0829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 13299 | MI | Yes |

## Other

- **Enumeration date:** 03/11/2008
- **Last updated:** 03/11/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013996537 | NPI | MI |
| 01 | — | 1598979676 | NPI | MI |