Provider Demographics
NPI:1124385596
Name:HERITAGE DENTAL CENTER PC
Entity Type:Organization
Organization Name:HERITAGE DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:RANGASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-996-9966
Mailing Address - Street 1:5263 RICHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2110
Mailing Address - Country:US
Mailing Address - Phone:810-726-9746
Mailing Address - Fax:
Practice Address - Street 1:5263 RICHFIELD RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2110
Practice Address - Country:US
Practice Address - Phone:810-726-9746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty