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General NPI Number Information
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NPI Number | 1558813360
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Entity Type | Organization
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Legal Business Name | HAVILAH DENTAL GROUP
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 9301 MAYFLOWER CT
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City | PLYMOUTH
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State | MI
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Zip | 48170-3923
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Country | US
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Telephone | 704-497-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 9301 MAYFLOWER CT
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City | PLYMOUTH
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State | MI
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Zip | 48170-3923
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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 | DIRECTOR
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Name | UVOH ONORIOBE
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Credential | DMD, MPH
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Telephone | 704-804-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22001
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License Number State | MI
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