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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