MEDICARE: HAVENS ORTHODONTICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901019327	MI

General Provider Information

NPI Number	:	1558630889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVENS ORTHODONTICS, PLLC

Provider Business Mailing Address
First Line	:	64845 VAN DYKE RD
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2836
Country	:	US
Telephone Number	:	586-752-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	64845 VAN DYKE RD
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2836
Country	:	US
Telephone Number	:	586-752-3504
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. DAVID CHRISTOPHER HAVENS
Credential	:	D.D.S., M.S.
Telephone Number	:	586-752-3504

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	06/20/2022

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