# IMMACULATE DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639085277
- **Authorized official:** DR. LEENA ATISHA DDS (SOLE MEMBER)
- **Authorized official phone:** (248) 312-8255

## Contact information

- **Practice address:** 4060 HAGGERTY RD, COMMERCE TOWNSHIP, MI 48390-1313
- **Practice address phone:** (248) 363-0480
- **Mailing address:** 34078 GLOUSTER CIR, FARMINGTON HILLS, MI 48331-4700
- **Mailing address phone:** (248) 312-8255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2026
- **Last updated:** 08/22/2026