1760528632 NPI number — AMERICAN PROFESSIONAL PERIODONTICS

Table of content: DR. ANGELA K. MILLER MD (NPI 1790818797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760528632 NPI number — AMERICAN PROFESSIONAL PERIODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN PROFESSIONAL PERIODONTICS
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:
GREAT EXPRESSION DENTAL CENTERS
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:
1760528632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E LONG LAKE
Provider Second Line Business Mailing Address:
STE 311
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-203-1100
Provider Business Mailing Address Fax Number:
248-203-1112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E LONG LAKE
Provider Second Line Business Practice Location Address:
STE 311
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-203-1100
Provider Business Practice Location Address Fax Number:
248-203-1112
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECKMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-203-1100

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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