Healthcare Provider Details

I. General information

NPI: 1720172141
Provider Name (Legal Business Name): HURON DENTAL ASSOCIATES, P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18757 HURON RIVER DR
NEW BOSTON MI
48164-9357
US

IV. Provider business mailing address

18757 HURON RIVER DR
NEW BOSTON MI
48164-9357
US

V. Phone/Fax

Practice location:
  • Phone: 734-753-5000
  • Fax:
Mailing address:
  • Phone: 734-753-5000
  • 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: DIANE AN HAMEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-383-6800