Healthcare Provider Details

I. General information

NPI: 1275401093
Provider Name (Legal Business Name): BDD ARW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 MAIN ST
BIRCH RUN MI
48415-8001
US

IV. Provider business mailing address

333 W 1ST ST
ELMHURST IL
60126-2641
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-9381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MOORE
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 832-704-4262