Provider Demographics
NPI:1174688162
Name:ALLEN RD. DENTAL CENTER P.C.
Entity Type:Organization
Organization Name:ALLEN RD. DENTAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-675-8844
Mailing Address - Street 1:22150 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2271
Mailing Address - Country:US
Mailing Address - Phone:734-675-8844
Mailing Address - Fax:734-675-0499
Practice Address - Street 1:22150 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2271
Practice Address - Country:US
Practice Address - Phone:734-675-8844
Practice Address - Fax:734-675-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty