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General NPI Number Information
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NPI Number | 1235406497
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Entity Type | Organization
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Legal Business Name | IN-HOME DENTAL CARE, INC.
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1600 PINETREE DR
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City | TRENTON
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State | MI
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Zip | 48183-1754
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Country | US
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Telephone | 734-330-1562
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 FORT ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-3036
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Country | US
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Telephone | 734-330-1562
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS LYNN MICHELLE ARMATIS
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Credential | RDH, BS
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Telephone | 734-330-1562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902013865
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License Number State | MI
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