1497878375 NPI number — WB DENTAL CENTERS P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497878375 NPI number — WB DENTAL CENTERS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WB DENTAL CENTERS P.C.
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:
Provider Other Organization Name Type Code:
6
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:
1497878375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45055 COBBLESTONE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48377-1395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-669-6608
Provider Business Mailing Address Fax Number:
248-681-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3435 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEEGO HARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48320-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-681-4660
Provider Business Practice Location Address Fax Number:
248-681-3610
Provider Enumeration Date:
04/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-669-6608

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2901018302 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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