Provider Demographics
NPI:1174044846
Name:MICHIGAN DENTAL ASSOCIATES II PC
Entity Type:Organization
Organization Name:MICHIGAN DENTAL ASSOCIATES II PC
Other - Org Name:CAMBRIDGE DENTAL CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSURANCE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-372-7358
Mailing Address - Street 1:999 PEACHTREE ST NE STE 800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4425
Mailing Address - Country:US
Mailing Address - Phone:678-372-7358
Mailing Address - Fax:
Practice Address - Street 1:27281 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1804
Practice Address - Country:US
Practice Address - Phone:313-274-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010138191223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty