Basic Information
| Provider Information | |||||||||
| NPI: | 1851468813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FASBINDER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 N UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481091012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346474450 | ||||||||
| FaxNumber: | 7346154784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 N UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481091012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346474450 | ||||||||
| FaxNumber: | 7346154784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901015898 | MI | X | Dental Providers | Dentist | 1223G0001X | 2901015898 | MI | X | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | D158980 | 01 | MI | BCBS OF MI | OTHER |