Healthcare Provider Details

I. General information

NPI: 1811506629
Provider Name (Legal Business Name): NORTHVILLE ARDENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42927 7 MILE RD
NORTHVILLE MI
48167-2277
US

IV. Provider business mailing address

42927 7 MILE RD
NORTHVILLE MI
48167-2277
US

V. Phone/Fax

Practice location:
  • Phone: 248-348-7997
  • Fax: 248-348-0119
Mailing address:
  • Phone: 248-348-7997
  • Fax: 248-348-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY FRANCES JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-348-7997