Provider Demographics
NPI:1083884092
Name:LIVONIA DENTAL CARE
Entity Type:Organization
Organization Name:LIVONIA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:NITZKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-427-7555
Mailing Address - Street 1:33428 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2860
Mailing Address - Country:US
Mailing Address - Phone:734-427-7555
Mailing Address - Fax:734-427-1233
Practice Address - Street 1:33428 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2860
Practice Address - Country:US
Practice Address - Phone:734-427-7555
Practice Address - Fax:734-427-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14658302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization