Healthcare Provider Details

I. General information

NPI: 1093023442
Provider Name (Legal Business Name): YPSILANTI FAMILY DENTAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N WASHINGTON ST
YPSILANTI MI
48197-2619
US

IV. Provider business mailing address

127 N WASHINGTON ST
YPSILANTI MI
48197-2619
US

V. Phone/Fax

Practice location:
  • Phone: 734-782-3500
  • Fax: 734-428-3248
Mailing address:
  • Phone: 734-782-3500
  • Fax: 734-428-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16618
License Number StateMI

VIII. Authorized Official

Name: DR. DARREN REGINALD MARSH
Title or Position: DENTIST
Credential: D.D.S
Phone: 734-482-3500