1699383695 NPI number — LAURICH DENTISTRY ANN ARBOR PLLC

Table of content: (NPI 1699383695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699383695 NPI number — LAURICH DENTISTRY ANN ARBOR PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURICH DENTISTRY ANN ARBOR PLLC
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:
LAURICH DENTISTRY ANN ARBOR
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:
1699383695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18618 MIDDLEBELT RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-476-1960
Provider Business Mailing Address Fax Number:
248-479-2805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2715 PACKARD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-975-6700
Provider Business Practice Location Address Fax Number:
734-975-9035
Provider Enumeration Date:
07/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KARACSON
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
248-476-1960

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com