1881998029 NPI number — TMG DENTAL HEALTH FOUNDATION, INC.

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 1881998029 NPI number — TMG DENTAL HEALTH FOUNDATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMG DENTAL HEALTH FOUNDATION, INC.
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:
1881998029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30835 W 10 MILE RD
Provider Second Line Business Mailing Address:
SUITE 5010
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48336-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-363-6004
Provider Business Mailing Address Fax Number:
248-542-3243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30835 W 10 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 5010
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-363-6004
Provider Business Practice Location Address Fax Number:
248-542-3243
Provider Enumeration Date:
01/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MURRAY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
313-363-6004

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  2901015910 , 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)

  • Identifier: 273182721 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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