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General NPI Number Information
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NPI Number | 1639219280
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Entity Type | Organization
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Legal Business Name | ABC FAMILY DENTAL LLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 2350 STONEBRIDGE DR BLDG H
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City | FLINT
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State | MI
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Zip | 48532-5406
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Country | US
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Telephone | 810-230-9091
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 STONEBRIDGE DR BLDG H
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City | FLINT
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State | MI
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Zip | 48532-5406
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Country | US
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Telephone | 810-230-9091
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHY ANN DINSER
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Credential |
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Telephone | 248-477-5888
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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 | 13011
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License Number State | MI
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