Provider Demographics
NPI:1346279916
Name:ADVANCED DENTAL CONCEPTS P.C.
Entity Type:Organization
Organization Name:ADVANCED DENTAL CONCEPTS P.C.
Other - Org Name:ADVANCED DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:IAQUINTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-348-8808
Mailing Address - Street 1:42450 W 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3013
Mailing Address - Country:US
Mailing Address - Phone:248-348-8808
Mailing Address - Fax:248-348-2133
Practice Address - Street 1:42450 W 12 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3013
Practice Address - Country:US
Practice Address - Phone:248-348-8808
Practice Address - Fax:248-348-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010138561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty