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General NPI Number Information
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NPI Number | 1891682712
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Entity Type | Organization
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Legal Business Name | NEW BOSTON FAMILY DENTAL
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 37228 HURON RIVER DR
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City | NEW BOSTON
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State | MI
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Zip | 48164-9286
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Country | US
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Telephone | 231-631-2118
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 TROTTERS POINTE CIR
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City | MIDLAND
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State | MI
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Zip | 48642-6859
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Country | US
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Telephone | 231-631-2118
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL BENJAMIN O'BRIEN
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Credential | DDS
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Telephone | 231-631-2118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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