Organization
LIVINGSTON DENTAL SLEEP THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN J PETERSBURG DDS (OWNER/DENTIST)
(810) 227-4224
Entity
Organization
Contact information
Practice address
8641 W GRAND RIVER AVE, SUITE 6, BRIGHTON, MI 48116-4353
(810) 227-4224
(810) 227-4660
Mailing address
8641 W GRAND RIVER AVE, SUITE 6, BRIGHTON, MI 48116-4353
(810) 227-4224
(810) 227-4660
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10174
MI
122300000X
Dentist
17224
MI
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
05/22/2013
Last updated
05/22/2013
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