Provider Demographics
NPI:1043480254
Name:ADVANCE DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:ADVANCE DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-742-6600
Mailing Address - Street 1:PO BOX 90539
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-0539
Mailing Address - Country:US
Mailing Address - Phone:810-742-6600
Mailing Address - Fax:810-742-5075
Practice Address - Street 1:3710 DAVISON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4206
Practice Address - Country:US
Practice Address - Phone:810-742-6600
Practice Address - Fax:810-742-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty