Provider Demographics
NPI:1407462187
Name:CANTON ARDENT
Entity Type:Organization
Organization Name:CANTON ARDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-657-3395
Mailing Address - Street 1:45650 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5432
Mailing Address - Country:US
Mailing Address - Phone:734-999-3366
Mailing Address - Fax:734-999-3368
Practice Address - Street 1:45650 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5432
Practice Address - Country:US
Practice Address - Phone:734-999-3366
Practice Address - Fax:734-999-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841553302OtherLENA MUSTAFA
MI1508985318OtherPARESH SHRIMANKAR
MI1053768432OtherSHARVIL SHAH