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General NPI Number Information
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NPI Number | 1245466911
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Entity Type | Organization
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Legal Business Name | GOLDEN DENTAL PLANS OF MICHIGAN, INC.
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 29377 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-3475
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Country | US
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Telephone | 586-573-8118
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Fax | 586-573-8720
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Provider Business Mailing Address
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Address Line | 29377 HOOVER RD
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City | WARREN
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State | MI
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Zip | 48093-3475
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Country | US
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Telephone | 586-573-8118
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Fax | 586-573-8720
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ANTHONY M. LENTINE
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Credential |
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Telephone | 586-573-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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