1760689350 NPI number — ALMONT DENTAL CENTRE, P.C.

Table of content: (NPI 1760689350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760689350 NPI number — ALMONT DENTAL CENTRE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALMONT DENTAL CENTRE, 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:
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:
1760689350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 465
Provider Second Line Business Mailing Address:
606 N. MAIN
Provider Business Mailing Address City Name:
ALMONT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48003-0465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-798-8585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMONT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48003-8553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-798-8585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEDDERMEYER
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS COORDINATOR
Authorized Official Telephone Number:
810-798-8585

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 14481 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1962502237 . This is a "DENTIST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1245342435 . This is a "DENTIST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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