Provider Demographics
NPI:1407987787
Name:FAMILY FIRST DENTAL CARE PC
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL CARE PC
Other - Org Name:JOHN C LEO DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-524-2828
Mailing Address - Street 1:1982 LIVERNOIS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-524-2828
Mailing Address - Fax:248-524-9666
Practice Address - Street 1:1982 LIVERNOIS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-524-2828
Practice Address - Fax:248-524-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty