Provider Demographics
NPI:1073744173
Name:ORION FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:ORION FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-482-0885
Mailing Address - Street 1:2002 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3143
Mailing Address - Country:US
Mailing Address - Phone:517-482-0885
Mailing Address - Fax:517-482-7445
Practice Address - Street 1:2002 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3143
Practice Address - Country:US
Practice Address - Phone:517-482-0885
Practice Address - Fax:517-482-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018410122300000X
MI901013605122300000X
MI012271122300000X
MI2901019279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty