Provider Demographics
NPI:1326670886
Name:PLYMOUTH ARDENT
Entity Type:Organization
Organization Name:PLYMOUTH ARDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-459-7110
Mailing Address - Street 1:40400 ANN ARBOR RD E STE 103
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4590
Mailing Address - Country:US
Mailing Address - Phone:734-459-7110
Mailing Address - Fax:734-459-0314
Practice Address - Street 1:40400 ANN ARBOR RD E STE 103
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4590
Practice Address - Country:US
Practice Address - Phone:734-459-7110
Practice Address - Fax:734-459-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1245760040OtherNPI
MI1053768432OtherNPI
MI1710930581OtherNPI