Healthcare Provider Details

I. General information

NPI: 1265859565
Provider Name (Legal Business Name): HARTRICK FAMILY DENTISTRY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32609 WOODWARD AVE
ROYAL OAK MI
48073-0952
US

IV. Provider business mailing address

32609 WOODWARD AVE
ROYAL OAK MI
48073-0952
US

V. Phone/Fax

Practice location:
  • Phone: 248-549-0950
  • Fax: 248-549-1180
Mailing address:
  • Phone: 248-549-0950
  • Fax: 248-549-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12800
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number12800
License Number StateMI

VIII. Authorized Official

Name: DR. NANCY HARTRICK
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 248-549-0950