Provider Demographics
NPI:1316007602
Name:ANCHOR BAY FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:ANCHOR BAY FAMILY DENTAL, PLLC
Other - Org Name:ANCHOR BAY DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-725-4311
Mailing Address - Street 1:35050 23 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-3606
Mailing Address - Country:US
Mailing Address - Phone:586-725-4311
Mailing Address - Fax:586-725-3588
Practice Address - Street 1:35050 23 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3606
Practice Address - Country:US
Practice Address - Phone:586-725-4311
Practice Address - Fax:586-725-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty