Healthcare Provider Details

I. General information

NPI: 1316048077
Provider Name (Legal Business Name): FAMILY DENTAL CENTER OF LIVONIA, P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28701 PLYMOUTH ROAD
LIVONIA MI
48150-2335
US

IV. Provider business mailing address

28701 PLYMOUTH ROAD
LIVONIA MI
48150-2335
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-9300
  • Fax: 734-427-1200
Mailing address:
  • Phone: 734-427-9300
  • Fax: 734-427-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016783
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017710
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018923
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902006805
License Number StateMI

VIII. Authorized Official

Name: MRS. FAITH TOBIN JACOBSON
Title or Position: DENTIST
Credential: DDS
Phone: 734-427-9300