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General NPI Number Information
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NPI Number | 1972920478
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Entity Type | Organization
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Legal Business Name | ADVANCED PERIODONTICS/IMPLANTOLOGY
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 40400 ANN ARBOR RD E SUITE 204A
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City | PLYMOUTH
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State | MI
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Zip | 48170-6615
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Country | US
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Telephone | 734-459-4077
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Fax | 734-459-4084
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Provider Business Mailing Address
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Address Line | 40400 ANN ARBOR RD E SUITE 204A
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City | PLYMOUTH
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State | MI
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Zip | 48170-6615
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Country | US
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Telephone | 734-459-4077
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Fax | 734-459-4084
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BRENDA F MURPHY
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Credential |
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Telephone | 734-459-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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