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General NPI Number Information
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NPI Number | 1336154285
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Entity Type | Organization
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Legal Business Name | FARMINGTON FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 39475 LEWIS DR SUITE 100
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City | NOVI
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State | MI
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Zip | 48377-2981
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Country | US
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Telephone | 248-553-3100
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Fax | 248-553-4115
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Provider Business Mailing Address
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Address Line | 39475 LEWIS DR SUITE 100
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City | NOVI
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State | MI
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Zip | 48377-2981
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Country | US
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Telephone | 248-553-3100
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Fax | 248-553-4115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD MAX FISHER
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Credential | D.D.S.
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Telephone | 248-553-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901016456
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License Number State | MI
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