Provider Demographics
NPI:1235724527
Name:TRU DENTAL MICHIGAN II, PLLC
Entity Type:Organization
Organization Name:TRU DENTAL MICHIGAN II, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:30100 TELEGRAPH RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4515
Mailing Address - Country:US
Mailing Address - Phone:248-642-5000
Mailing Address - Fax:248-642-5000
Practice Address - Street 1:30100 TELEGRAPH RD STE 111
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4515
Practice Address - Country:US
Practice Address - Phone:248-642-5000
Practice Address - Fax:248-642-5000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL MICHIGAN II, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty