Provider Demographics
NPI:1164506135
Name:PLYMOUTH DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:PLYMOUTH DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE INSURANCE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-420-2326
Mailing Address - Street 1:42801 SCHOOLCRAFT ROAD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170
Mailing Address - Country:US
Mailing Address - Phone:734-420-2326
Mailing Address - Fax:734-420-0078
Practice Address - Street 1:42801 SCHOOLCRAFT ROAD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170
Practice Address - Country:US
Practice Address - Phone:734-420-2326
Practice Address - Fax:734-420-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI123631223E0200X
MI183761223G0001X
MI98391223G0001X
MI83961223G0001X
MI102601223G0001X
MI118101223G0001X
MI158271223P0300X
MI164291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty