=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730876137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURBAR FAMILY DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2023
-----------------------------------------------------
Last Update Date | 04/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26370 GRAND RIVER AVE
-----------------------------------------------------
City | REDFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48240-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-534-3313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41289 LEHIGH LN
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 519-924-0104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGEY BURBAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-924-0104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------