Healthcare Provider Details

I. General information

NPI: 1467356436
Provider Name (Legal Business Name): FAMILY ORTHODONTICS OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30760 WOODWARD AVE
ROYAL OAK MI
48073-0918
US

IV. Provider business mailing address

100 GALLERIA PKWY SE STE 900
ATLANTA GA
30339-5947
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-1000
  • Fax:
Mailing address:
  • Phone: 770-692-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: JO ANN RICE
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 609-315-3851