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General NPI Number Information
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NPI Number | 1548996242
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Entity Type | Organization
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Legal Business Name | HAVENS ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 655 W 14 MILE RD
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City | CLAWSON
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State | MI
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Zip | 48017-1918
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Country | US
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Telephone | 248-280-2944
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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 |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID C HAVENS
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Credential |
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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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