Provider Demographics
NPI:1043608003
Name:TREE TOWN PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:TREE TOWN PEDIATRIC DENTISTRY PLLC
Other - Org Name:ASSOCIATES IN PEDIATRIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNGJOO
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-662-1591
Mailing Address - Street 1:1303 PACKARD ST
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3874
Mailing Address - Country:US
Mailing Address - Phone:734-662-1591
Mailing Address - Fax:734-662-1599
Practice Address - Street 1:1303 PACKARD ST
Practice Address - Street 2:SUITE #301
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3874
Practice Address - Country:US
Practice Address - Phone:734-662-1591
Practice Address - Fax:734-662-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty