Provider Demographics
NPI:1114300811
Name:ANN ARBOR PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:ANN ARBOR PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-663-2490
Mailing Address - Street 1:2074 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6962
Mailing Address - Country:US
Mailing Address - Phone:734-663-2490
Mailing Address - Fax:734-663-5137
Practice Address - Street 1:2074 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6962
Practice Address - Country:US
Practice Address - Phone:734-663-2490
Practice Address - Fax:734-663-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty