Provider Demographics
NPI:1801521034
Name:DYNAMIC HEALTH AND OCCUPATIONAL SERVICES
Entity type:Organization
Organization Name:DYNAMIC HEALTH AND OCCUPATIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WELZIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:313-359-1000
Mailing Address - Street 1:22976 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4279
Mailing Address - Country:US
Mailing Address - Phone:313-359-1000
Mailing Address - Fax:313-887-6360
Practice Address - Street 1:22976 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4279
Practice Address - Country:US
Practice Address - Phone:313-359-1000
Practice Address - Fax:313-887-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center