1174044846 NPI number — MICHIGAN DENTAL ASSOCIATES II PC

Table of content: (NPI 1174044846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174044846 NPI number — MICHIGAN DENTAL ASSOCIATES II PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHIGAN DENTAL ASSOCIATES II PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAMBRIDGE DENTAL CENTER PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174044846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 PEACHTREE ST NE STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-4425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-372-7358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27281 W WARREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48127-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-274-4040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HARP
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF INSURANCE OPERATIONS
Authorized Official Telephone Number:
678-372-7358

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2901013819 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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