Provider Demographics
NPI:1497985659
Name:DECAROLIS, GIANNI SANTE (DMD)
Entity type:Individual
Prefix:
First Name:GIANNI
Middle Name:SANTE
Last Name:DECAROLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W BIG BEAVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3912
Mailing Address - Country:US
Mailing Address - Phone:248-647-7930
Mailing Address - Fax:248-647-0576
Practice Address - Street 1:50 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3910
Practice Address - Country:US
Practice Address - Phone:248-647-7930
Practice Address - Fax:248-647-0576
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186811223E0200X
MI29010200901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics