Provider Demographics
NPI:1417690009
Name:CANTON PLYMOUTH FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:CANTON PLYMOUTH FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HETAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-981-8040
Mailing Address - Street 1:44757 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1071
Mailing Address - Country:US
Mailing Address - Phone:734-981-8040
Mailing Address - Fax:734-981-6432
Practice Address - Street 1:2200 N CANTON CENTER RD STE 100A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5037
Practice Address - Country:US
Practice Address - Phone:734-981-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty