Healthcare Provider Details

I. General information

NPI: 1730643818
Provider Name (Legal Business Name): 313 ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 HIGHLAND RD STE 22
HARTLAND MI
48353-2726
US

IV. Provider business mailing address

PO BOX 586
ROMEO MI
48065-0586
US

V. Phone/Fax

Practice location:
  • Phone: 586-242-6789
  • Fax:
Mailing address:
  • Phone: 586-242-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID HAVENS
Title or Position: OWNER
Credential: DDS, MS
Phone: 586-242-6789