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General NPI Number Information
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NPI Number | 1891936340
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Entity Type | Organization
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Legal Business Name | SUPERIOR FAMILY DENTAL
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 31393 W 13 MILE RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2297
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Country | US
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Telephone | 734-474-4703
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Fax |
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Provider Business Mailing Address
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Address Line | 31393 W 13 MILE RD SUITE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2297
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Country | US
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Telephone | 734-474-4703
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. RANDY FREIJ
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Credential | D.D.S.
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Telephone | 734-474-4703
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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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