Provider Demographics
NPI:1013591908
Name:IDEAL DENTISTRY OF NORTON SHORES
Entity Type:Organization
Organization Name:IDEAL DENTISTRY OF NORTON SHORES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-313-1843
Mailing Address - Street 1:755 SEMINOLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6561
Mailing Address - Country:US
Mailing Address - Phone:231-780-1100
Mailing Address - Fax:
Practice Address - Street 1:755 SEMINOLE RD STE 102
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-6561
Practice Address - Country:US
Practice Address - Phone:231-780-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental