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General NPI Number Information
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NPI Number | 1013591908
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Entity Type | Organization
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Legal Business Name | IDEAL DENTISTRY OF NORTON SHORES
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 755 SEMINOLE RD STE 102
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City | NORTON SHORES
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State | MI
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Zip | 49441-6561
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Country | US
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Telephone | 231-780-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 755 SEMINOLE RD STE 102
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City | NORTON SHORES
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State | MI
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Zip | 49441-6561
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Country | US
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Telephone | 231-780-1100
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AMANDA ROBERTSON
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Credential | DDS
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Telephone | 989-313-1843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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