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Organization
PRIME DENTAL PLLC
Active
Organization
PRIME DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SONA FISENKOVA DDS (DOCTOR/OWNER)
(248) 987-2879
Entity
Organization
Contact information
Practice address
32905 W 12 MILE RD STE 140, FARMINGTON HILLS, MI 48334-3343
(248) 987-2879
(248) 715-6367
Mailing address
32905 W 12 MILE RD STE 140, FARMINGTON HILLS, MI 48334-3343
(248) 987-2879
(248) 715-6367
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811380751
SELF
MI
Enumeration date
01/04/2019
Last updated
12/05/2022
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