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General NPI Number Information
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NPI Number | 1669515482
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Entity Type | Organization
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Legal Business Name | ADVANCED ENDODONTICS PC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 39525 W 14 MILE RD SUITE 103
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City | NOVI
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State | MI
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Zip | 48377-1632
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Country | US
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Telephone | 248-668-9103
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Fax | 248-668-9114
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Provider Business Mailing Address
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Address Line | 39525 W 14 MILE RD SUITE 103
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City | NOVI
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State | MI
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Zip | 48377-1632
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Country | US
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Telephone | 248-668-9103
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Fax | 248-668-9114
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY A HIRSCHMAN
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Credential | D.D.S, M.S.
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Telephone | 248-668-9103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2901017445
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License Number State | MI
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