Organization
SEVEN LAKES PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIEGO VELASQUEZ-PLATA DDS, MSD (PRESIDENT)
(810) 750-3400
Entity
Organization
Contact information
Practice address
1100 TORREY RD, SUITE 500, FENTON, MI 48430-3327
(810) 750-3400
Mailing address
1100 TORREY RD, SUITE 500, FENTON, MI 48430-3327
(810) 750-3400
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
18270
MI
Other
Enumeration date
01/05/2006
Last updated
08/22/2020
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