Provider Demographics
NPI:1023213196
Name:CAMBRIDGE DENTAL GROUP
Entity Type:Organization
Organization Name:CAMBRIDGE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-274-4040
Mailing Address - Street 1:27281 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1804
Mailing Address - Country:US
Mailing Address - Phone:313-274-4040
Mailing Address - Fax:313-274-8080
Practice Address - Street 1:27281 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1804
Practice Address - Country:US
Practice Address - Phone:313-274-4040
Practice Address - Fax:313-274-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty