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General NPI Number Information
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NPI Number | 1457933509
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Entity Type | Organization
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Legal Business Name | 734 ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1305 S MAIN ST
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City | CHELSEA
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State | MI
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Zip | 48118-1418
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Country | US
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Telephone | 734-475-9143
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 586
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City | ROMEO
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State | MI
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Zip | 48065-0586
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Country | US
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Telephone | 586-752-3504
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. DAVID CHRISTOPHER HAVENS
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Credential | DDS, MS
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Telephone | 586-242-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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